scholarly journals Risk Factors Predicting Recurrent Small Intestinal Resection for Crohn’s Disease of the Terminal Ileum

1994 ◽  
Vol 8 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Hanna Binder ◽  
Hugh J Freeman
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Laboratory ◽  
Average Length ◽  
Severe Disease ◽  
Intestinal Resection ◽  
Grade Group ◽  
Internal Fistula ◽  
Small Intestinal

This study examined potential risk factors for recurrent small intestinal resection in a ‘reagent-grade’ group of 94 consecutive patients with prior removal of histologically defined Crohn’s disease localized to the distal ileum seen by one gastroenterologist at a single teaching hospital. There were 38 males and 56 females ranging in age from 15 to 58 years, with an average length of follow-up of 8.7 years. Of these, 26% required a second resection for recurrent small intestinal disease. Cumulative reoperation rates in these 25 patients were 18% at five years and 24% at 10 years. Univariate and multivariate analyses of multiple demographic, clinical, laboratory and pathological variables revealed two apparent statistically significant independent risk factors for a second intestinal resection: steroid treatment, likely an indirect indication of more severe disease activity; and the presence of an internal fistula, consistent with the emerging concept of a relatively more aggressive clinical form of Crohn’s disease.

scholarly journals Prevalence Rates and an Evaluation of Reported Risk Factors for Osteonecrosis (Avascular Necrosis) in Crohn’s Disease

2000 ◽  
Vol 14 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Hugh J Freeman ◽  
Katy J Freeman
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Parenteral Nutrition ◽  
Avascular Necrosis ◽  
Intestinal Resection ◽  
Resonance Imaging ◽  
Small Intestinal ◽  
Metastatic Colon Carcinoma

Avascular necrosis (osteonecrosis) occurs in Crohn’s disease, but the rate of this particular complication is not known. Over 20 years, 877 patients with Crohn’s disease, 492 women (56.1%) and 385 men (43.9%), were evaluated with patient follow-up data available for a mean of 7.8 years. In this group, four men were seen with osteonecrosis. No woman was affected. All patients had typical radiological, magnetic resonance imaging or pathological changes of osteonecrosis involving the femoral heads, while two also had superimposed avascular necrosis involving the humeral heads. Patient ages ranged from 19 to 36 years at the time of diagnosis of their Crohn’s disease, and all were white. In one patient, disease was confined to the colon, while three patients had disease involving the terminal ileum and colon. Disease behaviour in two patients was classified as penetrating because of concomitant ischiorectal abscesses, while one patient developed a metastatic colon carcinoma. Ankylosing spondylitis was present in two patients, but no other extraintestinal manifestations developed. Two patients received corticosteroids as well as parenteral nutrition during the course of their disease. Two patients did not receive corticosteroids or parenteral nutrition. Of 877 patients with Crohn’s disease, 484 (55.1%) received corticosteroids during the course of the disease, 196 (22.4%) received at least one course of parenteral nutrition, and 125 (14.3%) received both corticosteroids and parenteral nutrition. A total of 311 patients (35.5%) had at least one small intestinal resection. The overall rate of avascular necrosis in Crohn’s disease was less than 0.5% but for men with Crohn’s disease was about 1%. In this series, risk of osteonecrosis could not be attributed to corticosteroid use, parenteral nutrition or both forms of therapy administered together. Small intestinal resection with loss of small intestinal absorptive area was not a risk factor for the development of osteonecrosis. Avascular necrosis (or osteonecrosis) is a very rare extraintestinal osseous complication that may occur in Crohn’s disease, independent of previously reported risk factors, including corticosteroids or parenteral nutrition with lipid emulsions.

scholarly journals P430 Prognostic significance of neuropeptide expression in ileal neural plexuses in Crohn’s disease. A retrospective study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S433-S433
Author(s):  
A Gklavas ◽  
D Tiniakos ◽  
D Karandrea ◽  
G Karamanolis ◽  
G Bamias ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Mast Cells ◽  
T Lymphocytes ◽  
Crohn's Disease ◽  
Resection Margin ◽  
Prognostic Significance ◽  
Intestinal Resection ◽  
Independent Risk Factors ◽  
Proximal Resection Margin

Abstract Background Intestinal resection in Crohn’s disease (CD) is not curative and the risk for postoperative recurrence (POR) remains high. Highlighting risk factors for POR is crucial for the postoperative management of CD patients. Myenteric plexitis is a well-established risk factors for POR. The primary purpose of this study was to evaluate the correlation of neuropeptide P (NPY)-, vasoactive intestinal peptide (VIP)- and substance P (SP)-ergic nerve density with the presence and severity of plexitis in myenteric and submucosal plexuses in the proximal resection margin. Secondary aims were to assess the value of abovementioned neuropeptides’ expression in predicting POR and to recognize additional risk factors. Methods We conducted a retrospective, single-center study on CD patients who underwent ileocolonic resection (ICR) between January 2010 and December 2016. Exclusion criteria were age <16 years, patients with missing or invalid data precluding analysis, the presence of a diverting ileostomy on enrollment and specimens inappropriate for the evaluation of histologic features of interest in the proximal resection margin. Demographic and clinical data were retrieved, and the incidence or endoscopic, clinical and surgical POR was recorded. The presence and severity of plexitis was evaluated by hematoxylin and eosin staining. Giemsa staining was used for the recognition of mast cells. Immunohistochemistry was used was used for the detection of T-lymphocytes and NPY-, VIP- and SP-ergic neurons. The expression of the above peptides was quantified using image analysis. Results Seventy-nine patients (44 males) with a median age of 35 years were included. The median follow-up was 71 months. Myenteric and submucosal plexitis were present in 83.5% and 73.4% of patients, respectively. No association was detected between the density of NPY, VIP and SP expression and the presence or severity of plexitis. Similarly, the number of the involved T-lymphocytes or mast cells was not correlated with the expression of these peptides. Univariate and multivariate Cox proportional regression analysis was performed for the detection of risk factors for POR. Smoking and moderate/severe myenteric plexitis were independent risk factors for endoscopic and clinical POR, whereas an involved ileal margin was recognized as a risk factor for clinical POR. Conclusion This study did not document a correlation between plexitis in proximal resection margin and the expression of specific neuropeptides. According to our findings, smoking, myenteric plexitis, and involved ileal margin are independent risk factors for POR.

scholarly journals Tailored Medical Management of the Complex Postoperative Crohn's Disease Patient

2019 ◽  
Vol 32 (04) ◽  
pp. 225-230 ◽  
Author(s):  
Jean-Paul Achkar
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Residual Disease ◽  
Disease Patient ◽  
Intestinal Resection ◽  
Disease Recurrence ◽  
Recurrence Rates ◽  
Patient Risk ◽  
Necrosis Factor

AbstractDespite advancements in medical therapy, many patients with Crohn's disease continue to require surgery for intestinal resection and/or management of perianal disease at some point in their disease course. Unfortunately, in this complex group of patients, postoperative disease recurrence rates are high. Medical prophylaxis can be used to prevent Crohn's disease recurrence or manage residual disease after surgery, but the ideal timing to start medications after surgery varies based on patient risk factors and patient preference for medication use. Currently, the largest medical treatment effects are seen with thiopurines and antitumor necrosis factor antibodies, but there are continually expanding options as new medical therapies are developed. A proposed algorithm stratified based on patient risk factors is provided.

scholarly journals Cross-disorder analysis of schizophrenia and 19 immune-mediated diseases identifies shared genetic risk

2019 ◽  
Vol 28 (20) ◽  
pp. 3498-3513 ◽  
Author(s):  
Jennie G Pouget ◽  
Buhm Han ◽  
Yang Wu ◽  
Emmanuel Mignot ◽  
Hanna M Ollila ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Genetic Risk ◽  
Genetic Risk Factors ◽  
Phenotypic Correlation ◽  
Biliary Cirrhosis ◽  
Genome Wide ◽  
Shared Genetic

Abstract Many immune diseases occur at different rates among people with schizophrenia compared to the general population. Here, we evaluated whether this phenomenon might be explained by shared genetic risk factors. We used data from large genome-wide association studies to compare the genetic architecture of schizophrenia to 19 immune diseases. First, we evaluated the association with schizophrenia of 581 variants previously reported to be associated with immune diseases at genome-wide significance. We identified five variants with potentially pleiotropic effects. While colocalization analyses were inconclusive, functional characterization of these variants provided the strongest evidence for a model in which genetic variation at rs1734907 modulates risk of schizophrenia and Crohn’s disease via altered methylation and expression of EPHB4—a gene whose protein product guides the migration of neuronal axons in the brain and the migration of lymphocytes towards infected cells in the immune system. Next, we investigated genome-wide sharing of common variants between schizophrenia and immune diseases using cross-trait LD score regression. Of the 11 immune diseases with available genome-wide summary statistics, we observed genetic correlation between six immune diseases and schizophrenia: inflammatory bowel disease (rg = 0.12 ± 0.03, P = 2.49 × 10−4), Crohn’s disease (rg = 0.097 ± 0.06, P = 3.27 × 10−3), ulcerative colitis (rg = 0.11 ± 0.04, P = 4.05 × 10–3), primary biliary cirrhosis (rg = 0.13 ± 0.05, P = 3.98 × 10−3), psoriasis (rg = 0.18 ± 0.07, P = 7.78 × 10–3) and systemic lupus erythematosus (rg = 0.13 ± 0.05, P = 3.76 × 10–3). With the exception of ulcerative colitis, the degree and direction of these genetic correlations were consistent with the expected phenotypic correlation based on epidemiological data. Our findings suggest shared genetic risk factors contribute to the epidemiological association of certain immune diseases and schizophrenia.

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