P221 Crohn’s disease patients unable to complete preoperative mechanical bowel preparation have increased risk of anastomotic complications: results of a prospective observational study

Abstract Background To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centers in Germany and the Czech Republic. Methods Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole/Paramomycin or Metronidazole/Neomycine. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was the occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intra-abdominal septic complications (IASC) which were defined as anastomotic leak, intra-abdominal abscess, fistula or peritonitis. Results Between 6/2016 and 3/2021, 157 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Forty (26%) developed complications from the MBP, mostly vomiting; twenty-nine patients (18.5%) were not able to complete the MBP. Female sex (HR 4.2, p=0.016) was associated with an increased probability of not being able to complete the MBP. Postoperative anastomotic leak occurred in 5 patients (3%). In a multivariate analysis, the risk of anastomotic leak was significantly higher in patients unable to complete the MBP (10.5%), as compared to patients with complete MBP (1.6%, p=0.01, HR 21.0). Postoperative IASC occurred in 7 patients (7%). Patients unable to complete preoperative MBP were at higher risk of developing IASC. However, the difference was not statistically significant (14% vs. 5%, p=0.12). Conclusion The anastomotic leak rate was low when preoperative MBP and oral antibiotics were used. However, patients not able to complete MBP might be at an increased risk.

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P557 Increased risk of anastomotic leak in Crohn’s disease patients unable to complete preoperative mechanical bowel preparation

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.685 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S472-S472

Author(s):

I Iesalnieks ◽

F Marek ◽

Z Kala ◽

L Kunovsky

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Anastomotic Leak ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Oral Antibiotics ◽

Septic Complications ◽

Increased Risk ◽

Postoperative Anastomotic Leak ◽

Colorectal Resections

Abstract Background To assess the risk of postoperative anastomotic leak in Crohn’s disease patients unable to complete the preoperative mechanical bowel preparation (MBP): a prospective observational study from two referral centres in Germany and the Czech Republic. Methods Preoperative MBP was used routinely in all Crohn’s disease patients undergoing elective ileocolic or colorectal resections completed by the formation of an anastomosis since 6/2016. The MBP consisted of 2 L Polyethyleneglycol (PEG) solution combined with two doses of oral antibiotics Metronidazole and Paromomycin. The MBP was defined as incomplete when patients were not able to drink the whole amount of PEG solution due to side effects or complications. The primary endpoint was occurrence of anastomotic leak. The secondary endpoint was the incidence of postoperative intraabdominal septic complications (IASC) which were defined as an anastomotic leak, intraabdominal abscess or fistula and peritonitis. Results Between 6/2016 and 11/2019, 96 Crohn’s disease patients underwent elective ileocolic or colorectal resections after receiving preoperative MBP and oral antibiotics. Twenty-four (25%) developed complications of MBP, mostly vomiting; 17 patients (18%) were not able to complete MBP. The presence of extraintestinal disease manifestations (Hazard Ratio 4.8, p = 0.029), preoperative weight loss (HR 5.7, p = 0.019) and female sex (HR 13.3, p = 0.005) were associated with an increased probability not to be able to complete MBP. Postoperative anastomotic leak occurred in 2 patients (2%). The risk of anastomotic leak was significantly higher in patients unable to complete MBP (12%) as compared with patients with complete MBP (0%, p = 0.03). Postoperative IASC occurred in 7 patients (7%). Patient unable to complete preoperative MBP were at higher risk to develop IASC; however, the difference was not statistically significant (18% vs. 5%, p = 0.10) Conclusion The anastomotic leak rate is very low when preoperative mechanical bowel preparation and oral antibiotics have been used. However, patients not able to complete MBP might be at an increased risk.

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Prospective observational study on Stelara (ustekinumab) assessing effectiveness in Crohn’s disease (PROSE): a 16-week follow-up

Scandinavian Journal of Gastroenterology ◽

10.1080/00365521.2021.1906946 ◽

2021 ◽

pp. 1-7

Author(s):

Anders Forss ◽

Mark Clements ◽

Pär Myrelid ◽

Hans Strid ◽

Charlotte Söderman ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Prospective Observational Study

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3 Anti-TNF in patients with an early course of Crohn's disease – a prospective observational study in Germany

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(13)60004-5 ◽

2013 ◽

Vol 7 ◽

pp. S2

Author(s):

B. Bokemeyer ◽

U. Helwig ◽

A. Stallmach ◽

N. Teich ◽

R. Halle ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Prospective Observational Study ◽

Early Course

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Clinical and Nutritional Impact of a Semi-Elemental Hydrolyzed Whey Protein Diet in Patients with Active Crohn’s Disease: A Prospective Observational Study

Nutrients ◽

10.3390/nu13103623 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3623

Author(s):

Blanca Ferreiro ◽

Silvia Llopis-Salinero ◽

Beatriz Lardies ◽

Carla Granados-Colomina ◽

Raimon Milà-Villarroel

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Nutritional Status ◽

Disease Activity ◽

Prospective Observational Study ◽

Elemental Diet ◽

Stool Frequency ◽

Nutritional Treatment ◽

The Mean

Background: Malnourishment is a common complication in patients with Crohn’s disease. Methods: An observational, prospective study was conducted to assess the nutritional status, disease activity, and stool frequency at baseline and after 12 weeks of treatment with a semi-elemental diet in patients with active Crohn’s disease. Results: A total of 144 patients with Crohn’s disease were included. The nutritional status improved after treatment, resulting in 76.1% of patients at low risk of malnourishment, 20.4% moderately malnourished, and 8.5% severely malnourished after 12 weeks of treatment. Nutritional status improvement was associated with the number of nutritional supplements. Mean albumin levels and body mass index (BMI) improved after 12 weeks of nutritional treatment (from 3.0 g/dL to 3.7 g/dL and from 20.2 kg/m2 to 21.1 kg/m2, respectively). A significant decrease in HBI was found after 12 weeks of nutritional treatment (from 10.2 to 3.7). The mean number of stools per day decreased with the 12 week semi-elemental diet (from 4.6 stools/day to 1.7 stools/day). Conclusion: In this observational study, the semi-elemental diet seemed effective in improving the nutritional status, disease activity, and stool frequency in patients with active Crohn’s disease.

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P015 ILEOCOLIC RESECTION FOR CROHN’S DISEASE: CURRENT TRENDS FROM ANALYSIS OF 2 YEARS OF NSQIP IBD COLLABORATIVE DATA

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.131 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S51-S52

Author(s):

William Luo ◽

Stefan Holubar ◽

Liliana Bordeianou ◽

Lynne Crawford ◽

Bruce Hall ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Anastomotic Leak ◽

Severe Disease ◽

Multivariable Analysis ◽

Ileocolic Resection ◽

Improvement Program ◽

Stoma Formation ◽

Increased Risk ◽

Secondary Outcomes

Abstract Background Ileocolic resection (ICR) is performed for Crohn’s disease (CD) patients with terminal ileitis requiring surgery. Current National Surgical Quality Improvement Program (NSQIP) data is lacking specificity around IBD surgery, including stoma formation and biologic therapies. The NSQIP IBD Collaborative (NSQIP-IBD) is a multicenter working group formed to better collect and analyze perioperative data unique to IBD patients under the auspices of NSQIP. We present retrospective analysis of a multicenter cohort of ICR for CD to describe the current practice of ICR for CD across our collaborative and explore factors associated with rates of postoperative complications on behalf of NSQIP-IBD. Methods Review of NSQIP data from 10 participating sites was performed to select ICR cases for CD from March 2017 to March 2019. In addition to standard data from NSQIP, IBD-specific data regarding stoma formation, immunosuppressant use (biologics, steroids, and immune modulators), and dysplasia is included. Primary outcome was anastomotic leak measured in a 30-day postoperative window in undiverted patients. Secondary outcomes were total non-leak complications and total postoperative infections. Multivariable analysis was performed to adjust for confounding pre- and intraoperative confounders. Backward selection of covariates and factors was performed using a cutoff of p<0.2 for main effects. Results 506 ICR cases for CD were identified. 78 patients had stomas per our unique ileostomy NSQIP-IBD variable, compared to 38 found by querying generally available NSQIP data (48.7% of total stomas). ICR patients receiving stoma were more likely to have more severe ASA class and weight loss and had significantly lower albumin and hematocrit. Age, BMI, and sex were similar in either group. Intraoperatively, stoma patients were more likely have worse wound class, be emergent, and longer operative time. 421 cases had complete baseline and intraoperative data for multivariable analysis of leak rates. 422 were available for secondary outcomes analysis. Multivariable analysis of leak rates showed significant association with infections prior to operation (PATOS; OR=6.6, 95% CI 1.1–40, p=0.041). Significant predictors of total postoperative complication rate and infection rate are shown in Tables 1 and 2, respectively. Conclusions NSQIP-IBD data provides clearer, more detailed data than the NSQIP colectomy module alone in IBD patients. We show that CD ICR patients receiving stomas were more emergent, had intraoperative infection, or had more severe disease. This is consistent with most contemporary surgical practices. Total infections PATOS are associated with increased risk of postoperative anastomotic leak, non-leak complications, and infections. NSQIP-IBD data improves on existing NSQIP data to allow a more robust analysis of factors and outcomes unique to IBD cases. We anticipate with more time and greater numbers we will be able to obtain even more granular data.

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A 5-Year Prospective Observational Study of the Outcomes of International Treatment Guidelines for Crohn's Disease

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2008.10.018 ◽

2009 ◽

Vol 7 (3) ◽

pp. 323-328 ◽

Cited By ~ 6

Author(s):

Garret Cullen ◽

Denise Keegan ◽

Hugh E. Mulcahy ◽

Diarmuid P. O'Donoghue

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Prospective Observational Study ◽

Treatment Guidelines

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Low dietary fiber promotes enteric expansion of a Crohn's disease-associated pathobiont independent of obesity

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00134.2021 ◽

2021 ◽

Author(s):

Trevor C. Lau ◽

Aline A. Fiebig-Comyn ◽

Christopher R. Shaler ◽

Joseph B. McPhee ◽

Brian K. Coombes ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Dietary Fiber ◽

Enteric Infection ◽

Oral Antibiotics ◽

High Fat ◽

E Coli ◽

Increased Risk ◽

Main Driver ◽

Dietary Component

Obesity is associated with metabolic, immunological, and infectious disease comorbidities, including an increased risk of enteric infection and inflammatory bowel disease such as Crohn's disease (CD). Expansion of intestinal pathobionts such as adherent-invasive Escherichia coli (AIEC) is a common dysbiotic feature of CD, which is amplified by prior use of oral antibiotics. Although high-fat, high-sugar diets are associated with dysbiotic expansion of E. coli, it is unknown if the content of fat or another dietary component in obesogenic diets is sufficient to promote AIEC expansion. Here, we found that administration of an antibiotic combined with feeding mice an obesogenic low fiber, high sucrose, high fat diet (HFD) that is typically used in rodent obesity studies promoted AIEC intestinal expansion. Even a short-term (i.e., 1-day) pulse of HFD feeding before infection was sufficient to promote AIEC expansion, indicating that the magnitude of obesity was not the main driver of AIEC expansion. Controlled diet experiments demonstrated that neither dietary fat nor sugar were the key determinants of AIEC colonization, but that lowering dietary fiber from approximately 13% to 5-6% was sufficient to promote intestinal expansion of AIEC when combined with antibiotics in mice. When combined with antibiotics, lowering fiber promoted AIEC intestinal expansion to a similar extent as widely used HFDs in mice. However, lowering dietary fiber was sufficient to promote AIEC intestinal expansion without affecting body mass. Our results show that low dietary fiber combined with oral antibiotics are environmental factors that promote expansion of Crohn's disease-associated pathobionts in the gut.

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