scholarly journals Natural History and Risk Stratification of Recurrent Crohn’s Disease After Ileocolonic Resection: A Multicenter Retrospective Cohort Study

2021 ◽  
Author(s):  
Vincent Joustra ◽  
Marjolijn Duijvestein ◽  
Aart Mookhoek ◽  
Willem Bemelman ◽  
Christianne Buskens ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Prophylactic Treatment ◽  
Risk Profile ◽  
Postoperative Treatment ◽  
British Society ◽  
Risk Profiles ◽  
Clinical Risk ◽  
Ileocolonic Resection

Abstract Background Prediction of endoscopic postoperative recurrence (POR) and prophylactic treatment based on clinical risk profile have thus far been inconclusive. This study aimed to examine the association between clinical risk profile and the development of endoscopic POR in a Crohn’s disease population without postoperative treatment and to identify individual risk factors of endoscopic POR. Methods Medical records of 142 patients with Crohn’s disease during follow-up after ileocecal or ileocolonic resection without prophylactic treatment at 3 referral centers were reviewed. Endoscopic POR was defined as a modified Rutgeerts score ≥i2b. Clinical risk profiles were distilled from current guidelines. Both uni- and multivariate logistic regression analysis were used to assess the relationship between risk profiles and endoscopic POR. Results Endoscopic POR was observed in 68 out of 142 (47.9%) patients. Active smoking postsurgery (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.24-7.34; P = 0.02), a Montreal classification of A3 (OR, 3.05; 95% CI, 1.07-8.69; P = 0.04), and previous bowel resections (OR, 2.58; 95% CI, 1.07-6.22; P = 0.03) were significantly associated with endoscopic POR. No significant association was observed between endoscopic POR and any guideline defined as a high-/low-risk profile. However, patients with a combination of any 3 or more European Crohns & Colitis Organisation– (OR, 4.87; 95% CI, 1.30-18.29; P = 0.02) or British Society of Gastroenterology–defined (OR 3.16; 95% CI, 1.05-9.49; P = 0.04) risk factors showed increased odds of developing endoscopic POR. Conclusions Our results suggest that patients with a combination of any 3 or more European Crohns & Colitis Organisation– or British Society of Gastroenterology–defined risk factors would probably benefit from immediate prophylactic treatment.

scholarly journals P229 Environmental and clinical risk factors for severe Crohn's disease

2014 ◽  
Vol 8 ◽  
pp. S157-S158
Author(s):  
N. Azzopardi ◽  
P. Ellul ◽  
S. Chetcuti ◽  
G. Laferla
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Risk Factors ◽  
Clinical Risk

scholarly journals Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn’s Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie

2019 ◽  
Vol 13 (12) ◽  
pp. 1510-1517 ◽  
Author(s):  
Solafah Abdalla ◽  
Antoine Brouquet ◽  
Léon Maggiori ◽  
Philippe Zerbib ◽  
Quentin Denost ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Postoperative Morbidity ◽  
Multivariate Analyses ◽  
Therapeutic Option ◽  
Anastomotic Complications ◽  
Conversion Rates ◽  
Significant Difference ◽  
Ileocolonic Resection

Abstract Background and Aims To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn’s disease [CD]. Methods From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. Results IICR patients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% in the PICR group [p = 0.024]. There was no significant difference between IICR and PICR regarding septic intra-abdominal complications, anastomotic leakage [8.8% vs 8.4%] or temporary stoma requirement. IICR patients were more likely to present with non-infectious complications and ileus [11.8% vs 3.7%, p < 0.001]. Uni- and multivariate analyses did not identify specific risk factors of overall postoperative morbidity in the IICR group. Conclusions Surgery for recurrent CD is associated with a slight increase of non-infectious morbidity [postoperative ileus] that mainly reflects the technical difficulties of these procedures. However, IICR remains a safe therapeutic option in patients with recurrent CD because severe morbidity including anastomotic complications is similar to patients undergoing primary resection. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast

Mo1763 Clinical Risk Factors for Crohn's Disease Postoperative Recurrence are Reflected in Alterations in Mucosally Adherent Microbiota at Surgical Resection

2012 ◽  
Vol 142 (5) ◽  
pp. S-679
Author(s):  
Aravinth U. Murugananthan ◽  
Phil Tozer ◽  
David Bernardo Ordiz ◽  
Ailsa Hart ◽  
Stella C. Knight ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Surgical Resection ◽  
Postoperative Recurrence ◽  
Clinical Risk Factors ◽  
Clinical Risk

Sa1131 Determining Patient & Disease Related Risk Factors for Intra-Abdominal Septic Complications Following Ileocolonic Resection for Crohn's Disease Within a Tertiary Institution

2014 ◽  
Vol 146 (5) ◽  
pp. S-207-S-208
Author(s):  
Pritesh Morar ◽  
Jonathan D. Hodgkinson ◽  
Kanyada Koysombat ◽  
Samantha Thalayasingam ◽  
Ailsa L. Hart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Tertiary Institution ◽  
Septic Complications ◽  
Related Risk ◽  
Ileocolonic Resection

Prominence of ileal mucosa-associated microbiota to predict postoperative endoscopic recurrence in Crohn’s disease

Gut ◽  
2019 ◽  
Vol 69 (3) ◽  
pp. 462-472 ◽  
Author(s):  
Harry Sokol ◽  
Loic Brot ◽  
Carmen Stefanescu ◽  
Claire Auzolle ◽  
Nicolas Barnich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Alpha Diversity ◽  
Clinical Risk Factors ◽  
Ileal Mucosa ◽  
16S Sequencing ◽  
Time Of Surgery ◽  
Clinical Risk ◽  
Endoscopic Recurrence

ObjectiveFollowing ileal resection for Crohn’s disease (CD), recurrence is very frequent. Although several clinical risk factors of recurrence have been identified, predicting relapse remains challenging. Performing an ileocolonoscopy within the first year after surgery is currently recommended to assess endoscopic recurrence and to adjust the treatment. We took advantage of a large prospective multicentric cohort to investigate the role of the ileal mucosa-associated microbiota in postoperative endoscopic recurrence.Patients and methodsIleal mucosa-associated microbiota was analysed by 16S sequencing at the time of surgery and/or of endoscopic evaluation in 201 patients (288 samples in total) prospectively recruited in France.ResultsIleal mucosa-associated microbiota exhibits profound changes following surgery in CD. Compared with non-recurrence setting, endoscopic recurrence is associated with strong changes in ileal mucosa-associated microbiota that are highly reminiscent of those observed generally in ileal CD compared with healthy subjects with a reduction in alpha diversity, an increase in several members of the Proteobacteria phylum and a decrease in several members of the Lachnospiraceae and the Ruminococcaceae families within the Firmicutes phylum. At the time of surgery, we identified several bacterial taxa associated with endoscopic recurrence and that can better predict relapse than usual clinical risk factors.ConclusionSurgery has an important impact on ileal mucosa-associated microbiota. Postoperative endoscopic recurrence is associated with changes in microbiota composition and alpha diversity. The gut microbiota has the potential to predict postoperative evolution and recurrence.

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