scholarly journals P618 Post-operative Crohn’s disease patients undergoing colonoscopy require significantly more analgesia and sedation compared with a non-IBD population

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S514-S514
Author(s):  
C Rowan ◽  
M Janjua ◽  
C Foley ◽  
J Burke ◽  
K Boland ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Significant Proportion ◽  
Intestinal Resection ◽  
Patient Characteristics ◽  
Median Dose ◽  
Electronic Reporting ◽  
Significant Difference ◽  
System Data

Abstract Background Rates of surgical intervention in Crohn’s disease have declined. However, a significant proportion of patients still require surgical resection and have been shown to have higher post-op pain scores and analgesia requirements. The aim of this study was to assess sedation requirements and comfort scores of post-operative Crohn’s disease patients at endoscopy. Methods Patients with a previous intestinal resection undergoing colonoscopy in 2017 were identified using an electronic reporting system. Data regarding patient demographics, disease characteristics, sedation requirements, comfort scores and endoscopy reports were collected. Patients with Crohn’s disease were compared with a non-IBD post-op population. Results n = 153 patients were included. n = 56 Crohn’s disease, n = 2 UC and n = 95 non-IBD patients underwent colonoscopy. Patient characteristics in Table 1. 13.6% of patients had a documented history of chronic pain or other relevant conditions that may affect comfort scores. 68.3% of patients with Crohn’s disease were on therapy at the time of endoscopy. The median dose of midazolam administered was 3 mg (IQR 2–4 mg); median fentanyl dose was 50 μg. (IQR 50–75 μg). The median dose of Midazolam was significantly higher in patients with Crohn’s disease (3 mg IQR 3–4 mg vs. 3 mg IQR 2–3; p = 0.006). The median dose of fentanyl required was also significantly higher in post-operative Crohn’s patients (50 μg IQR 50–100 μg vs. 50 μg; p = 0.001). The median comfort score in Crohn’s disease patients was higher (indicating more discomfort) when compared with the non-IBD cohort. (median score 2 and 1 respectively) There was no significant difference in the proportion of patients with chronic pain or multiple intestinal resections (p = 0.84 and p = 0.142). There was a statistically significant difference in comfort scores;n = 19 Crohn’s disease patients (39.6%) had comfort score 1, compared with n = 70 non-IBD patients (71.4%) (p = 0.04). There was no significant difference in the median doses of midazolam or fentanyl when comparing Crohn’s disease patients with and without active endoscopic disease. (p = 0.07 and p = 0.10 respectively). Conclusion Patients with Crohn’s disease undergoing colonoscopy in the post-operative setting have significantly higher analgesia requirements. Comfort scores are significantly worse when compared with non-IBD patients who have had similar intestinal resections. Endoscopists should use techniques, e.g. CO2 insufflation in addition to medication to ensure comfort amongst patients with Crohn’s disease.

scholarly journals P502 Tumour necrosis factor antagonists are superior to anti-integrin and anti-IL-12/23 therapies for preventing postoperative recurrence in adult Crohn’s disease patients requiring postoperative therapy

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S436-S437
Author(s):  
T Nakamura ◽  
R Shah ◽  
M Sachs ◽  
S Chang ◽  
D Hudesman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Propensity Score ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Intestinal Resection ◽  
Postoperative Recurrence ◽  
Treatment Groups ◽  
Significant Difference ◽  
Necrosis Factor

Abstract Background Crohn’s disease (CD) recurrence is common after surgical resection. Prior data have demonstrated that postoperative tumour necrosis factor antagonists (anti-TNF) may reduce recurrence, although little is known about the efficacy of other biologic therapies. The aim of this study was to compare biologic type and timing for preventing postoperative objective recurrence in adult CD patients. Methods We performed a retrospective chart review of CD patients who underwent intestinal resection from 2009 to 2019 at two academic medical centres. We tabulated baseline variables against treatment groups based on the type of postoperative biologic (anti-TNF, anti-integrin, anti-IL-12/23) and timing of postoperative biologic initiation (before or after 6 months post-op). Propensity score matching was utilised for treatment groups using baseline variables as predictors. Recurrence was defined by endoscopy (>i2 Rutgeerts’ score) or radiography (active inflammation in neoterminal ileum). Survival analysis was performed to assess risk of recurrence by treatment group and timing of biologic initiation. Results One hundred and forty-four patients were included (51% male, 13.2% active smokers, 97.9% stricturing and/or penetrating CD, 41.7% prior resection). The majority of patients received anti-TNF therapy. Adjusting for the propensity scores, fewer patients relapsed under anti-TNF compared with anti-integrin (HR 2.87, 1.04–7.99; p = 0.042) and anti-IL-12/23 (HR 3.51, 1.51–8.14; p = 0.03). There was no significant difference in objective relapse between patients on postoperative anti-TNF and no therapy (HR 0.71, 0.31–1.66; p = 0.44) (Figure 1). More patients relapsed when biologics were started after 6 months postoperatively compared with within 6 months (HR = 0.20, 0.08–0.53; p = 0.001) and never started (HR = 0.26, 0.11–0.59; p = 0.001) (Figure 2). Conclusion Among propensity score-adjusted CD patients, initiation of biologics within 6 months and anti-TNF agents were superior in preventing postoperative recurrence among patients receiving postoperative biologic therapy.

scholarly journals Meckel's Diverticulum in Crohn's Disease

2001 ◽  
Vol 15 (5) ◽  
pp. 308-311 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Small Intestine ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Meckel’S Diverticulum ◽  
Intestinal Resection ◽  
Patient Characteristics ◽  
Meckel's Diverticulum ◽  
Unexpected Finding ◽  
Imaging Studies

Meckel's diverticulum is a congenital abnormality of the distal ileum associated with failed vitelline duct closure. Detailed pathological studies have estimated its frequency to be about 2% of the general population, and it has been anecdotally recorded in patients with Crohn's disease. Most patients with Crohn's disease have imaging studies of the small intestine during the course of their disease, and often, an intestinal resection. Thus, it seems possible to estimate the prevalence of Meckel's diverticula in Crohn's disease. In addition, patient characteristics may be important, especially if management of Crohn's disease is altered. Of 877 patients with Crohn's disease, 10 (about 1%) had a Meckel's diverticulum diagnosed, including six men and four women. All were diagnosed with Crohn's disease before age 50 years and seven were diagnosed before age 30 years. There were five with ileocolonic disease, two with colon-only disease and three with ileum-only disease. The clinical behaviour of five patients could be classified as penetrating and two as stricturing. A total of 311 patients had an ileocolonic resection, including eight (about 2%) with a Meckel's diverticulum. In contrast to some case reports, no heterotopic mucosa was detected and the Meckel's diverticulum was incidental and, apparently, an unexpected finding. In each case, the diverticulum was not involved with Crohn's disease but was included in the ileal resection. These results suggest that the overall prevalence of a Meckel's diverticulum is not increased in Crohn's disease but may result in resection of additional small intestine.

scholarly journals High serum concentrations of growth differentiation factor-15 in male Crohn’s disease patients with low skeletal muscle index

2021 ◽  
Author(s):  
Hiroyuki Yamamoto ◽  
Fuminao Takeshima ◽  
Masafumi Haraguchi ◽  
Kayoko Matsushima ◽  
Moto Kitayama ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Handgrip Strength ◽  
Intestinal Resection ◽  
Bioelectrical Impedance ◽  
Japanese Patients ◽  
High Serum ◽  
Skeletal Muscle Index ◽  
Significant Difference

Abstract Sarcopenia is defined as low skeletal muscle index (SMI) in addition to low muscle strength (MS) or low physical function, and many biomarkers have been reported. In Crohn's disease (CD), low SMI is associated with predictors and complications of intestinal resection. Therefore, in many reports of CD, sarcopenia was defined only by SMI. However, there have been no reports of MS in Japan. Our study aimed to investigate the frequency of sarcopenia by assessing both SMI and MS in Japanese patients with CD and biomarkers predicting low SMI. We evaluated SMI using bioelectrical impedance analysis, handgrip strength, and blood tests, including CRP, ALB, IL-6, TNFα, GDF-8, and GDF-15 as biomarker candidates for 78 CD patients in our hospital. Sarcopenia and low SMI were 8% and 42.3%, respectively. Each candidate biomarker and SMI were negatively correlated with GDF-15 (Pearson's r=-0.414, P = 0.0031) in males and positively correlated with ALB (r = 0.377, P = 0.048), and negatively correlated with IL-6 (r=-0.484, P = 0.012) in females. Multivariate analysis adjusted for these items, age, and BMI showed a significant difference in male GDF-15 (P = 0.011, OR: 7.86, 95% CI: 1.09–56.58). Therefore, GDF-15 in male patients is considered a biomarker of low SMI.

Anxiety and Depression in Patients with Abdominal Bloating

1993 ◽  
Vol 38 (7) ◽  
pp. 475-479 ◽  
Author(s):  
Ji-Yung Song ◽  
Harold Merskey ◽  
Stephen Sullivan ◽  
Sam Noh
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Sex Education ◽  
Depression Scale ◽  
Normal Subjects ◽  
Anxiety And Depression ◽  
Childhood Experience ◽  
Personality Variables ◽  
Abdominal Bloating ◽  
Significant Difference

Eighteen patients with a syndrome of abdominal bloating and discomfort were examined to explore the relationship between their symptoms and their emotional problems. They were compared with 33 patients with Crohn's disease and 38 normal, healthy volunteers. Using the Hospital Anxiety and Depression Scale, patients with bloating were found to resemble patients with Crohn's disease. Both groups showed increased anxiety and depression. After controlling for age, sex, education, occupation, personality variables and childhood experience, there was a trend towards more anxiety in the bloating group compared with normal subjects and a significant difference for depression. These characteristics appear to be related to the effects of the illness or to selection, but not to personality or childhood experience. Although psychiatric problems are common among patients with abdominal bloating and pain who stay in touch with a clinic, they are not the primary cause of the disorder.

scholarly journals Appendiceal Carcinoids In Crohn’s Disease

2003 ◽  
Vol 17 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Carcinoid Tumour ◽  
Intestinal Resection ◽  
Case Review ◽  
Appendiceal Neoplasms ◽  
Increased Risk ◽  
Intestinal Neoplasms ◽  
Resection Specimen ◽  
Sporadic Cases

Earlier investigations demonstrate an increased risk for colon cancer in Crohn's disease. For other intestinal neoplasms, such as carcinoids, studies are limited. In Crohn's disease, repeated endoscopic and imaging studies along with intestinal resections may facilitate clinical recognition of neoplastic diseases, including appendiceal neoplasms. To date, however, only sporadic cases of appendiceal carcinoids have been described in Crohn's disease. In the present study, in a single clinician database of 1000 Crohn's disease patients, three of the 441 patients who had undergone intestinal resection had appendiceal carcinoids, all of which were pathologically confirmed. All were observed in female patients and were not suspected before surgical treatment. In one case, even though management was not altered, the tumour had already invaded serosal fat indicating a potential for more advanced disease. In this series, a carcinoid tumour was found in a resection specimen during a later clinical case review and another was a microcarcinoid, implying that these tumours may be overlooked in Crohn's disease. The percentage detected in the entire database (0.3%) exceeds the reported rates of detection of appendiceal carcinoids after removal of the appendix for appendicitis, as well as the rate of detection of appendiceal carcinoids in autopsy studies. This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease.

scholarly journals P652 Underweight patients with Crohn’s disease and without vitamin D supplementation are at high risk of vitamin D deficiency

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S536-S537
Author(s):  
D Vranesic Bender ◽  
V Domislović ◽  
M Brinar ◽  
D Ljubas Kelečić ◽  
I Karas ◽  
...  
Keyword(s):  
Vitamin D ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Lower Range ◽  
Total Study Population ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
Underweight Patients

Abstract Background Vitamin D deficiency is frequently present in inflammatory bowel disease (IBD) with a higher incidence in Crohn’s disease (CD) than in ulcerative colitis (UC). Given the involvement of the alimentary tract, many factors can contribute to vitamin D deficiency. The aim of the study was to investigate the association of vitamin D deficiency according to body mass index (BMI) in adult patients with IBD. Methods A cross-sectional study was conducted on a cohort of 152 IBD patients, 68.1% (n = 104) CD and 31.9% (n = 48) UC. The mean age of the total study population was 37.3±11.8 years and 57.3% (n = 87) were male. All patients were adult, Caucasian and without vitamin D supplementation. Patients were recruited during one year period. Results Out of all IBD patients, 60.5% (n = 92) had vitamin D deficiency, 32.2%, (n = 49) insufficiency and 7.2% (n = 11) sufficiency. According to BMI categories there were 12.5% (n = 19) obese patients, 27.6% (n = 42) overweight, 51.3% (n = 78) with normal body weight, and 8.6% (n = 13) underweight. There was a significant difference in vitamin D levels according to different BMI categories in terms of underweight patients having the lowest vitamin D levels; underweight 29.84±11.94 mmol/l, normal 46 ± 20.7 mmol/l, overweight 48±20.1 mmol/l, obese 51±15.3 mmol/l. In addition, there was a significant correlation of vitamin D levels and BMI values (Rho = 0.212, 95% CI 0.069–0.345, p = 0.004), which was more clearly observed in the lower range of BMI values (Figure 1). Male underweight patients had lower levels of vitamin D compared with female patients (26.6 ± 9 vs. 34.7 ± 5.6, p < 0.05). Both patients with CD and UC had significant positive correlation of vitamin D levels and BMI values (UC Rho=0.40, 95% CI 0.16–0.59, p = 0.001, UC Rho = 0.27, 95% CI 0.01–0.05, p = 0.044). However, when comparing vitamin D levels according to phenotype, a significant difference in vitamin D levels was observed in underweight CD (28.4 ± 11.1) comparing to underweight UC patients (40.6 ± 10.6), p < 0.05. In logistic regression analysis, CD phenotype was risk factor for vitamin D deficiency (OR 2.18 95% CI 1.01–4.72, β = 1.22, p = 0.04). Conclusion Our results on untreated IBD patients show a high proportion of vitamin D deficiency both in CD and UC, and significant correlation of vitamin D levels and BMI values, especially in the lower range of BMI values. Moreover, underweight CD patients have lower vitamin D levels comparing to UC. This suggests the need for regular vitamin D monitoring and supplementation especially in IBD patients at risk.

scholarly journals Decreasing Trends in Intestinal Resection and Re-Resection in Crohn's Disease

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Evelien M. J. Beelen ◽  
C. Janneke van der Woude ◽  
Marie J. Pierik ◽  
Frank Hoentjen ◽  
Nanne K. de Boer ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Resection

P077 A NOVEL PREDICTIVE NOMOGRAM FOR EARLY ENDOSCOPIC RECURRENCE AFTER INTESTINAL RESECTION FOR CROHN’S DISEASE

2019 ◽  
Vol 25 (Supplement_1) ◽  
pp. S37-S37
Author(s):  
Atsuyo Ikeda ◽  
Norikatsu Miyoshi ◽  
Shiki Fujino ◽  
Hideki Iijima ◽  
Hidekazu Takahashi ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Resection ◽  
Endoscopic Recurrence

scholarly journals Biologics and surgical outcomes in Crohn’s disease: is there a direct relationship?

2020 ◽  
Vol 13 ◽  
pp. 175628482093173
Author(s):  
Abel Botelho Quaresma ◽  
Takayuki Yamamoto ◽  
Paulo Gustavo Kotze
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Direct Relationship ◽  
Significant Proportion ◽  
Perioperative Period ◽  
Prospective Data ◽  
Treatment Algorithms ◽  
The Relationship ◽  
Necrosis Factor

Despite significant advances in medical therapy in the management of Crohn’s disease (CD), surgery is still required in a significant proportion of patients and constitutes an important tool in treatment algorithms. Recently, more options of biological agents have been made available, and most patients with CD undergoing surgical procedures have been previously exposed to this class of drugs. There is controversy in the literature as to whether anti-tumor necrosis factor (TNF) agents, anti-integrins, or anti-interleukins (ILs) have a direct relationship with increased postoperative complications. In this narrative review, the authors summarize the most important data regarding the effect of biologics on postoperative outcomes in CD. Most studies (with different designs) are based on the experience with anti-TNF agents, mostly with infliximab. Some studies outlined the relationship between vedolizumab and postoperative complications, and there is a lack of data with ustekinumab in this scenario. Most studies are retrospective, but few prospective data are available. A cause–effect (proof of concept) direct relationship between biologics and an increase in postoperative morbidity has not been demonstrated to date. Several confounding factors such as previous use of steroids, malnutrition, and unfavorable abdominal conditions have a definitely effect on postoperative complications in CD. Biologics seem safe to be used in the perioperative period, but available data are still controversial. Multidisciplinary individualized decisions should be made on a case-to-case basis, adapting the surgical strategy according to risk factors involved.

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