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 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 Computed tomography and magnetic resonance imaging in the diagnosis of the small and large intestine strictures in Crohn’s disease. Radiological semiotics and assessment of the inflammation activity

2018 ◽  
Vol 46 (7) ◽  
pp. 725-733
Author(s):  
S. E. Dubrova ◽  
G. A. Stashuk ◽  
N. V. Nikitina ◽  
Yu. K. Bogomazov
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Chronic Inflammation ◽  
Intestinal Wall ◽  
Arterial Phase ◽  
Resonance Imaging ◽  
Active Inflammation ◽  
Delayed Phase ◽  
Small And Large Intestine

Rationale: Crohn's disease is characterized by continuous severe course, and in a half of the patients is associated with formation of strictures that are difcult to treat and signifcantly decrease quality of life. Difculties during the differentiation between inflammation-related and fbrostenotic strictures and divergent approaches to their treatment in patients with Crohn's disease indicate the need in precise diagnostics and systematization of the radiological semiotics of strictures.Aim: To propose radiological semiotics of the small and large intestine strictures based on the results of multiaxial computed tomography (MACT) and magnetic resonance imaging (MRI).Materials and methods: MACT and MRI visualization was performed in 40 patients with a stenotic type of Crohn's disease.Results: The radiological signs of the strictures were classifed into two main groups: intestinal and extra-intestinal. They were systematized according to nine criteria, such as character of formation, etiology, number, inflammation grade, extension, shape, and location, presence of ileus and presence of other complications. The inflammation activity in the intestinal wall was evaluated during the postcontrast assessment: active inflammation in the arterial phase (at 25 seconds after administration of the contrast agent), chronic inflammation in the delayed phase (at 10 minutes). The MRI results were cross-checked with those of MACT. At the precontrast stage, MRI was more informative as per the width of the intestinal lumen, whereas MACT was preferential in the diagnosis of fat infltration of the intestinal wall. Post-contrast MACT and MRI were diagnostically equivalent. The most indicative for active inflammation were diffuse weighed MRI images, arterial phase MACT and MRI, whereas chronic inflammation and wall fbrosis were better diagnosed at the delayed phase (at 10 minutes) of MACT and MRI. Both methods (MACT and MRI) could not differentiate between the submucous and muscular layers of the intestinal wall. Mixed type of inflammation was seen in the walls of intestinal strictures: chronic inflammation dominated in the intermediate, most extensive part of a stricture and remained stable during the dynamic follow-up, whereas active inflammation was found in the marginal parts of the strictures, which were most susceptible to changes during the follow-up.Conclusion: Based on a set of certain signs obtained by radiological visualization, we propose a registry for stricture assessment based on evaluation of the inflammation activity.

scholarly journals Causes and Prognosis of Intestinal Failure in Crohn’s Disease: An 18-year Experience From a National Centre

2020 ◽  
Vol 14 (11) ◽  
pp. 1558-1564 ◽  
Author(s):  
Mattias Soop ◽  
Haroon Khan ◽  
Emma Nixon ◽  
Antje Teubner ◽  
Arun Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Parenteral Nutrition ◽  
Intestinal Failure ◽  
Anastomotic Dehiscence ◽  
Septic Complication ◽  
Kaplan Meier

Abstract Background and Aims Intestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. Methods Consecutive adult patients referred to a national intestinal failure unit over 2000–2018 with a diagnosis of CD, and subsequently treated with parenteral nutrition during at least 12 months, were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records. Results A total of 121 patients were included. Of these, 62 [51%] of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery; small bowel resection, primary disease activity, and proximal stoma were less common causes [31%, 12%, and 6%, respectively]. Further, 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently; 14% of patients developed intestinal failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 years.2 Conclusions IF is a severe complication of CD, with 60% of patients permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors, and structured pre-operative optimisation may reduce the incidence of IF in CD.

scholarly journals P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S579-S580
Author(s):  
A Frontali ◽  
M Rottoli ◽  
A Chierici ◽  
G Poggioli ◽  
Y Panis
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Antibiotic Prophylaxis ◽  
Success Rate ◽  
Rectovaginal Fistula ◽  
Univariate Analysis ◽  
Diverting Stoma ◽  
Prospective Database

Abstract Background Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients. Methods We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy). Results Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196). Conclusion Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.

Complications and risk factors - pancreatitis in children with Crohn’s disease treated with infliximab: prospective 1-year-follow-up

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S119
Author(s):  
Áron Cseh ◽  
Katalin Eszter Müller ◽  
Kriszta Boros ◽  
Antal Dezsőfi ◽  
András Arató ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease

scholarly journals Effectiveness and Safety of Ustekinumab Intensification at 90 mg Every 4 Weeks in Crohn’s Disease: A Multicentre Study

2020 ◽  
Author(s):  
Mathurin Fumery ◽  
Laurent Peyrin-Biroulet ◽  
Stephane Nancey ◽  
Romain Altwegg ◽  
Cyrielle Gilletta ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Events ◽  
Multicentre Study ◽  
Clinical Remission ◽  
Intestinal Resection ◽  
Serious Adverse Events ◽  
Faecal Calprotectin ◽  
Loss Of Response

Abstract Background The approved maintenance regimens for ustekinumab in Crohn’s disease [CD] are 90 mg every 8 or 12 weeks. Some patients will respond partially to ustekinumab or will experience a secondary loss of response. It remains poorly known if these patients may benefit from shortening the interval between injections. Methods All patients with active CD, as defined by Harvey–Bradshaw score ≥ 4 and one objective sign of inflammation [C-reactive protein > 5 mg/L and/or faecal calprotectin > 250 µg/g and/or radiological and/or endoscopic evidence of disease activity] who required ustekinumab dose escalation to 90 mg every 4 weeks for loss of response or incomplete response to ustekinumab 90 mg every 8 weeks were included in this retrospective multicentre cohort study. Results One hundred patients, with a median age of 35 years [interquartile range, 28–49] and median disease duration of 12 [7–20] years were included. Dose intensification was performed after a median of 5.0 [2.8–9.0] months of ustekinumab treatment and was associated with corticosteroids and immunosuppressants in respectively 29% and 27% of cases. Short-term clinical response and clinical remission were observed in respectively 61% and 31% after a median of 2.4 [1.3–3.0] months. After a median follow-up of 8.2 [5.6–12.4] months, 61% of patients were still treated with ustekinumab, and 26% were in steroid-free clinical remission. Among the 39 patients with colonoscopy during follow-up, 14 achieved endoscopic remission [no ulcers]. At the end of follow-up, 27% of patients were hospitalized, and 19% underwent intestinal resection surgery. Adverse events were reported in 12% of patients, including five serious adverse events. Conclusion In this multicentre study, two-thirds of patients recaptured response following treatment intensification with ustekinumab 90 mg every 4 weeks.

scholarly journals P115 Real-world experience of peri-operative treatments on surgical complications after Ileo-caecal resection in Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S193-S194
Author(s):  
S Di Stefano ◽  
C Liefferinckx ◽  
A Cremer ◽  
L Amininejad ◽  
A Van Gossum ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anastomotic Leakage ◽  
Surgical Complications ◽  
Protective Role ◽  
Infectious Complications ◽  
Surgical Recurrence ◽  
The Impact

Abstract Background The current recommendations remain vague as to whether biologics are safe or deleterious when surgery is contemplated in patients with Crohn’s disease (CD). Conflicting data do not enable to adopt a definitive position on the time to surgery. The aims of this study were to evaluate the impact of perioperative treatments on the rate of surgical complications and to report surgical recurrence rate of CD after ileo-caecal (IC) resection. Methods This was a retrospective monocentric cohort study of consecutive CD patients who underwent IC resection between 1996 and 2018. An ethical committee has been approved (P2019/376). The overall rate of surgical complications was evaluated within 30 days after surgery. The effect of pre- and postoperative treatments was assessed on overall morbidity, general and infectious complications, anastomotic leakage and risk factors. Statistical analyses were performed using SPSS. Results Demographic data of the 165 CD patients who underwent a primary IC resection are presented in Table 1. The median age at time of the first IC resection was 35 years (IQR 24–44) while the median follow-up was 6.1 years (IQR 1–11). The overall rate of complications was 18% including 8.7% and 3.3% patients with infectious complications and anastomotic leakage, respectively. No risk factors have been found to be associated with surgical complications. In particular, immunosuppressants and biologics did not increase the risk of surgical complications. Twenty-four per cent of patients (n = 39/160) needed a second IC resection due to stenosis at the anastomosis site in 69.2% of cases (n = 27/39). Surgical recurrence was found to increase linearly over time with a second surgery after a median follow-up of 8 years (IQR 2–12). Anti-TNF used as post-operative treatment had a protective role on surgical recurrence in multivariable regression with odd ration (OR) of 0.15, p = 0.001 (Table 2). Conclusion Prevalence of complications after an IC resection in CD patients was of 18% in this retrospective monocentric cohort. No risk factors were found to be associated with surgical complications. Anti-TNF seems to have a protective role on surgical recurrence.

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