Pathophysiology and Risk Factors for Cholelithiasis in Patients with Crohn’s Disease

Cholelithiasis is more common in patients with Crohn’s disease (CD) than in the healthy population. The aim here was to examine risk factors for cholelithiasis in a cohort of CD patients and to compare the prevalence of cholelithiasis in a cohort of CD patients with that in a control group. This was a single-center retrospective case-control study. The cohort comprised all consecutive CD patients who underwent abdominal ultrasound from January 2007 to January 2018. The control group comprised age- and gender-matched non-CD patients referred for upper gastrointestinal tract dyspepsia. The study included 238 CD patients and 238 controls. The prevalence of cholelithiasis in the CD and control groups was 12.6 % and 9.2 %, respectively (risk ratio (RR), 1.36; p=0.24). Univariate analysis revealed that cholelithiasis was associated with multiple risk factors. Multivariate analysis identified age (OR, 1.077; 95 % CI, 1.043–1.112; p<0.001) and receipt of parenteral nutrition (OR, 1.812; 95 % CI, 1.131–2.903; p=0.013) as independent risk factors for cholelithiasis in CD patients. The prevalence of cholelithiasis in CD patients was higher than that in the control group; however, the difference was not statistically significant. Age and receipt of parenteral nutrition were independent risk factors for cholelithiasis in CD patients.

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa060 ◽

2020 ◽

Vol 14 (11) ◽

pp. 1558-1564 ◽

Cited By ~ 1

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.

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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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.848 ◽

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.

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The Polymorphism rs17525495 of LTA4H Is Associated with Susceptibility of Crohn’s Disease instead of Intestinal Tuberculosis in a Chinese Han Population

BioMed Research International ◽

10.1155/2019/9537050 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Zi-qi Yu ◽

Wen-fei Wang ◽

Chuan-zhi Zhu ◽

Ke-hong Zhang ◽

Xin-chun Chen ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Extrapulmonary Tuberculosis ◽

Intestinal Tuberculosis ◽

Taqman Assay ◽

Jiangxi Province ◽

Control Group ◽

Healthy Population ◽

Therapeutic Effects ◽

Chinese Han

Background. Because of the similarity of intestinal tuberculosis and Crohn’s disease in disease phenotype, differential diagnosis has always been a clinical problem. Arachidonic acid metabolites play an important role in the inflammatory response of intestinal tuberculosis and Crohn’s disease. Recent studies have shown that the polymorphism locus in the promoter region of LTA4H gene affects LTB4 expression level and the susceptibility to extrapulmonary tuberculosis. Thus, we identified a total of 148 patients with intestinal tuberculosis, 145 with Crohn’s disease, and 700 normal controls in this study. Methods. All the study participants were local Han people from Jiangxi Province in the past eleven years. DNA was extracted from the paraffin-embedded specimens or the whole blood. The LTA4H promoter SNP (rs17525495) was genotyped with TaqMan assay. Results. The T-alleles frequency was not significantly increased in patients with intestinal tuberculosis compared with healthy control group (p=0.630; OR=1.07; 95%CI=0.81-1.41), while patients with Crohn’s disease have significantly increased T allele frequency compared with healthy population (p=0.032; OR=1.34; 95%CI=1.03-1.75). During treatment, the presence of the T allele significantly increased the proportion of Crohn’s patients requiring glucocorticoids (p<0.05). Conclusions. The T allele of LTA4H gene SNP (rs17525495) is a risk factor for Crohn’s disease instead of intestinal tuberculosis. More importantly, there may be a potential association of the different genotypes of rs17525495 with the treatment efficacy of 5-ASA and glucocorticoids in patients with Crohn’s disease. The association between LTA4H polymorphism and drugs therapeutic effects might contribute to the practice of precision medicine and the prediction of clinical outcomes.

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A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

Gastroenterology Research and Practice ◽

10.1155/2020/4863542 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Zhi-Jie Wang ◽

Qian Liu

Keyword(s):

Risk Factors ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Univariate Analysis ◽

Control Group ◽

Primary Malignancy ◽

Laparoscopic Anterior Resection ◽

Diverting Stoma ◽

Independent Risk Factors ◽

Intraoperative Chemotherapy

Background. Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods. This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results. In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P=0.047), intraoperative chemotherapy (P=0.003), and level of anastomosis (P=0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P=0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P=0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P=0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions. Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.

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Fistulizing pattern in Crohn's disease and pancolitis in ulcerative colitis are independent risk factors for cancer: A single-center cohort study

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2011.11.005 ◽

2012 ◽

Vol 6 (5) ◽

pp. 578-587 ◽

Cited By ~ 23

Author(s):

Livia Biancone ◽

Sara Zuzzi ◽

Micaela Ranieri ◽

Carmelina Petruzziello ◽

Emma Calabrese ◽

...

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Cohort Study ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Single Center ◽

Independent Risk Factors

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Risk factors of hypothyroxinemia in premature infants

10.21203/rs.3.rs-449944/v1 ◽

2021 ◽

Author(s):

Aslan Yilmaz ◽

Yavuz Özer ◽

Nesrin Kaya ◽

Hande Turan ◽

Hazal Cansu Acar ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Risk Factor ◽

Gestational Age ◽

Univariate Analysis ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Postnatal Life ◽

Thyroid Function Tests ◽

Retrospective Case

Abstract Background: Hypothyroxinemia is defined by low levels of thyroxine (T4) despite low or normal levels of thyroid-stimulating hormone (TSH). This study aimed to evaluate the risk factors associated with transient hypothyroxinemia (THOP) in premature newborn.Method: This is a single center, retrospective, case-control study. Premature newborns, between 24-34 weeks of gestation, hospitalised between January 2014-December 2019 in our Newborn Intensive Care Unit (NICU) were analyzed through their medical records. Thyroid function tests were routinely performed between the 10th and 20th days of postnatal life and were evaluated according to the gestational age references. Thirty six risk factors (prenatal and postnatal parameters, medical treatments, clinical diagnoses and applications in NICU) were searched in the patient group with THOP (n=71) and the control group with euthyroid prematures (n=73). The risk factors for THOP were identified by univariate analysis, followed by multivariate analysis. Results: Mean gestational ages of the study and the control groups were 29.7 ± 2.48 and 30.5 ± 2.30 weeks, respectively (p = 0.606). The birth weight, small for gestational age (SGA), intraventricular hemorrhage (IVH), congenital heart disease (CHD) were found to be the risk factors for THOP in the univariate analysis and CHD (p=0.033, odds ratio [OR]:3.7, 95% confidence interval [CI]: 1.1-12.3), BW (p=0.012, OR:0.998, 95% CI: 0.9-1.01) and SGA (p=0.006, OR:5.3, 95% CI: 1.6-17.71) were found to be an independent risk factor for THOP as a result of the multivariate analysis.Conclusıons: Although some treatment practices might have had direct effects on pituitary–thyroid axis, associated with the severity of the newborn clinical conditions, non of them was found to be a risk factor for THOP. However, preterm babies with CHD and SGA could have more risk for THOP.

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

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.554 ◽

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.

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Risk factors of necrotizing enterocolitis in neonates with sepsis: A retrospective case-control study

International Journal of Immunopathology and Pharmacology ◽

10.1177/2058738420963818 ◽

2020 ◽

Vol 34 ◽

pp. 205873842096381

Author(s):

Zheng-Li Wang ◽

Yao An ◽

Yu He ◽

Xiao-Yu Hu ◽

Lu Guo ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Blood Cell ◽

Necrotizing Enterocolitis ◽

Red Blood Cell ◽

Late Onset ◽

Univariate Analysis ◽

Red Blood Cell Transfusion ◽

Control Group ◽

Retrospective Case

Sepsis, a severe infectious disease in the neonatal period, is considered a risk factor for necrotizing enterocolitis (NEC). To investigate the specific risk factors for NEC in septic infants, septic infants admitted to our center from January 2010 to April 2018 were included. Septic neonates with proven NEC (Bell’s stage ⩾II) were enrolled in the NEC group, and those without NEC were enrolled in the control group. Demographics, clinical characteristics, and risk factors were compared between the two groups. Univariate and logistic regression analyses were used to evaluate the potential risk factors for NEC. A total of 610 septic neonates were included, of whom 78 (12.8%) had complicated NEC. The univariate analysis indicated that infants with NEC had a lower birth weight, a lower gestational age, and older age on admission than those without NEC ( P < 0.05). Higher rates of anemia, prolonged rupture of membranes (PROM) (⩾18 h), pregnancy-induced hypertension, late-onset sepsis (LOS), red blood cell transfusion and hypoalbuminemia were observed in the NEC group than in the non-NEC group (P<0.05). Logistic regression analysis revealed LOS ( P = 0.000), red blood cell transfusion ( P = 0.001) and hypoalbuminemia ( P = 0.001) were associated with the development of NEC. Among NEC infants, those who needed red blood cell transfusion had a longer hospitalization duration than those who did not need transfusion ( P < 0.05). LOS, red blood cell transfusion and hypoalbuminemia were independent risk factors for the development of NEC in infants with sepsis. Taking measures to reduce the occurrence of hypoproteinemia and severe anemia may help to reduce the occurrence of NEC in septic neonates.

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Patients’ Educational Program Could Improve Azathioprine Adherence in Crohn’s Disease Maintenance Therapy

Gastroenterology Research and Practice ◽

10.1155/2020/6848293 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Lei Wang ◽

Rong Fan ◽

Chen Zhang ◽

Liwen Hong ◽

Tianyu Zhang ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Maintenance Therapy ◽

Educational Program ◽

Demographic Data ◽

Univariate Analysis ◽

Educational Group ◽

One Year ◽

Relapse Rates

Aim. To determine the risk factors of nonadherence to azathioprine (AZA) maintenance therapy for Crohn’s disease (CD) and to evaluate the influence of patients’ educational program on adherence to AZA maintenance therapy. Methods. Patients receiving AZA as maintenance therapy for CD were enrolled. Demographic data, clinical data, and usage information were collected. Univariate and multivariate analyses were performed to identify the risk factors of nonadherence. Then, patients’ educational program was conducted. One year after the program, the improvements in adherence and relapse rates were compared between educational and noneducational groups. Results. A total of 378 CD patients receiving AZA as maintenance therapy were enrolled from September 2008 to September 2018. Nonadherence occurred in 43.9% (166/378) of patients. Univariate analysis revealed that young age, education, alcoholism, anxiety, depression, concern belief, and lack of necessity belief and AZA knowledge were risk factors of nonadherence (P<0.05). Multivariate logistic regression showed that anxiety (OR 6.244, 95% CI 2.563–15.213), depression (OR 3.801, 95% CI 1.281–11.278), and concern belief (OR 19.531, 95% CI 3.393–120.732) were independent risk factors of nonadherence. Necessity belief (OR 0.961, 95% CI 0.925–0.999) and AZA knowledge (OR 0.823, 95% CI 0.758–0.903) were protective factors of adherence. One year after the AZA educational program, the necessity belief, AZA knowledge, and adherence of the educational group significantly improved (P<0.05). Concern belief was significantly lower in the educational group than that in the noneducational group (P<0.05). Moreover, the noneducational group suffered significantly higher endoscopic relapse rates than that the educational group (15.9% vs. 30.1%, P=0.035). Conclusions. Nonadherence occurred frequently in CD patients receiving AZA maintenance therapy. Educational programs could improve patients’ adherence mainly by promoting their beliefs and knowledge of AZA and could reduce relapse rates during treatment.

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DOP62 Morbidity after primary ileocecal resection for Crohn’s disease in the years of biologics: Lesson learned over 631 patients exclusively treated in a tertiary centre

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.101 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S101-S102

Author(s):

M Rottoli ◽

M Tanzanu ◽

G Vago ◽

A Belvedere ◽

D Parlanti ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Treatment ◽

Univariate Analysis ◽

Preoperative Assessment ◽

High Volume ◽

Ileocecal Resection ◽

Tertiary Centre ◽

Major Complications

Abstract Background Several risk factors for morbidity after surgery for Crohn’s disease of the terminal ileum have already been identified. However, the study population is rarely homogeneous, due to high-volume centres receiving patients treated in other hospitals with diverging medical protocols and different thresholds for surgical referral. A study including only patients undergoing homogeneous perioperative treatment in a single referral centre might reduce the selection bias. The aim of this study was to identify the risk factors for minor (Clavien-Dindo ≤2) and major (Clavien-Dindo ≥3) postoperative complications in patients who received medical treatment and surgery in a single centre. Methods Retrospective analysis of ileocecal resections for Crohn’s disease in biological era (2004–2019). Recurrence was excluded. Risk factors for minor and major complications were identified through univariate and multivariable logistic regression analyses. Variables were selected by univariate analysis with p < 0.2 criteria, then a stepwise selection with entry criteria p = 0.05 and stay criteria p = 0.1. Results Of 631 patients included (59.4% male, median age 37 years), 214 (34%) had previous surgery and 152 (24.1%) biologics. Laparoscopy was feasible in 35.9% of cases, 285 patients (45.1%) required surgery on other bowel sites due to multiple locations or fistulae. 281 (44.5%) patients presented with fistulizing disease. Risk factors for 90-day minor complications (22.8%). Risk factors for 90-day major complications (6.8%). Conclusion Risk of minor complications was higher in younger patients, especially after a longer medical treatment. Fistulating disease increases the risks only if the rectum and sigmoid colon are involved. Major complications seem to be related to specific patient’s comorbidities, rather than disease characteristics. Onset of hypertension and neuro-vascular disease, known adverse events of chronic steroid use, should not be underestimated in the preoperative assessment of patients. Poor nutritional status greatly increased the risk of minor and major complications; therefore, any effort should be made towards the nutritional optimisation of Crohn’s patients

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