scholarly journals The risk factors for complications after Crohn’s Disease  surgery .

2021 ◽  
Author(s):  
Ilker Ozgur ◽  
Bora Karip ◽  
Cemil Burak Kulle ◽  
Bilger Cavus ◽  
Recep Ercin Sonmez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Demographic Data ◽  
Late Complication ◽  
Complication Rates ◽  
Abdominal Abscess ◽  
Colonic Involvement ◽  
Stoma Formation ◽  
The Mean

Abstract Background: Crohn’s disease needs a multidisciplinary approach and surgery will ultimately be necessary for most patients. Complications usually occur after surgery. Objective : This study aims to present complication rates in surgically treated Crohn's disease patients at a single institution and to determine possible risk factors. Methods: A retrospective analysis of 112 consecutive surgery performed on Crohn’s disease patients between 2003 and 2015. The demographic data, patient and disease characteristics, surgery type, and complications were analyzed. Results: Of 112 patients, 64 (57.1%) were male and 48 (42.9%) were female. The mean age was 34 (18-78) years. The mean follow-up was 114±32.4 (61-197) months. The most common early complications were intra-abdominal abscess formation (n=10, 8.9%) and wound infection (n=7, 6.26%). The incisional hernia was the most common late complication (n=4, 3.6%). Non-modifiable disease features associated with complications were colonic involvement of the disease (p=0.001), penetrating disease character (p=0.037), stoma formation (p=0.000), fistula (p=0.008) and concomitant fistula and intra-abdominal abscess (p=0.043) existence. Stoma formation was found to be an independent risk factor for complications (p=0.001). Conclusions: Colonic involvement, penetrating disease, fistula, concomitant abscess and fistula, and stoma formation were identified as non-modifiable risk factors for complications after surgery for Crohn’s disease.

scholarly journals Inflammatory Bowel Disease in Indo-Canadians with and without Antineutrophil Cytoplasmic Autoantibodies

2000 ◽  
Vol 14 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Hugh James Freeman
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Severe Disease ◽  
Colonic Disease ◽  
Male Predominance ◽  
Duration Of Residence ◽  
Colonic Involvement ◽  
The Mean ◽  
Antineutrophil Cytoplasmic Autoantibodies

A sequentially evaluated cohort of Indo-Canadians with either ulcerative colitis or Crohn’s disease were prospectively examined for antineutrophil cytoplasmic autoantibodies (ANCA). Of 84 patients, 62 had ulcerative colitis and 22 had Crohn’s disease. About one-third were born in Canada, and two-thirds were migrants from India or other countries, particularly East African nations. There was a disease-based and geographically based male predominance. The mean age of Canadian-born patients was significantly less than that of those born in other countries. Moreover, for migrants, the mean duration of residence in Canada before developing disease was 8.9 years for Crohn’s disease patients and 13.5 years for ulcerative colitis patients. Moderate to severe disease was present; virtually all those with Crohn’s disease had colonic involvement, and most of those with ulcerative colitis had extensive colonic disease. Overall, 40 of 84 (48%) were seropositive for ANCA, including a majority of those with ulcerative colitis but not Crohn’s disease. In addition, eight had cytoplasmic ANCA, a reported seromarker for extensive colitis. Seropositive and seronegative patients were similar in age, sex, birth or duration of residence in Canada, site and severity of disease, familial history and complications, including pouchitis. This study supports the view that these diseases arise in individuals with a genetic predisposition following exposure to some, as yet unknown, environmental factor.

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

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.

scholarly journals Early Laparoscopic Ileal Resection for Localized Ileocecal Crohn’s Disease: Hard Sell or a Revolutionary New Norm?

2021 ◽  
pp. 1-8
Author(s):  
Beatriz Yuki Maruyama ◽  
Christopher Ma ◽  
Remo Panaccione ◽  
Paulo Gustavo Kotze
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Therapy ◽  
Surgical Intervention ◽  
Management Plan ◽  
Early Surgery ◽  
Optimal Timing ◽  
Complication Rates ◽  
Advantages And Disadvantages ◽  
Stoma Formation

<b><i>Background:</i></b> Despite reductions in surgical rates that have been observed with earlier use of biological therapy, surgery still constitutes an important tool in the therapeutic armamentarium in Crohn’s disease (CD), particularly in patients with stenotic and penetrating phenotypes. In these scenarios, early surgical intervention is recommended, as bowel damage is present and irreversible, leading to lower efficacy with biologics. <b><i>Summary:</i></b> The concept of early surgery in CD supposes the possible advantages of better surgical outcomes in luminal CD after initial resection. Optimal timing of surgical intervention is associated with better postoperative outcomes, whilst delays can lead to more technically difficult and extensive procedures, which may result in an increase in postoperative complication rates and higher rates of stoma formation. Furthermore, data from the LIR!C trial have demonstrated that early surgery in luminal localized inflammatory ileocecal CD is an adequate alternative to medical therapy, with lower societal costs in the long term. In this review, we discuss the position of early resection in ileocecal CD by critically reviewing available data, describing the ideal patients to be considered for early surgery, and weighing the potential advantages and disadvantages of an early surgery paradigm. <b><i>Key Messages:</i></b> While early surgery may not be the right choice for every patient, the ultimate decision regarding whether surgical or medical therapy should come first in the treatment paradigm must be individualized for each patient based on the disease characteristics, phenotype, risk factors, and personal preference. This highlights the importance of the multidisciplinary team, which remains a key pillar in deciding the overall management plan for patients with CD.

scholarly journals Perioperative Use of Vedolizumab in Crohn’s Disease Patients and Surgical Outcomes

2021 ◽  
pp. 144-154
Author(s):  
Mohammed Alfawaz
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Postoperative Complication ◽  
Surgical Outcomes ◽  
Surgical Intervention ◽  
Considerable Proportion ◽  
Complication Rates ◽  
Postoperative Results ◽  
Direct Association

Despite advancement in managing Crohn’s disease (CD), a considerable proportion of cases still need surgical intervention, which is an essential means in therapy algorithms. Other drugs of the biologics are recently available, while most CD cases having operations have previously received a drug of this class. This class of agents has a direct association with higher postoperative complication rates, which raises a lot of controversies. In this review summarize the essential data concerning the vedolizumab effect on CD’s postoperative results. The previous data did not demonstrate a cause-effect absolute connection between the increased postoperative morbidities and vedolizumab. Many routing factors unquestionably affect CD’s postoperative outcomes and complications, like malnutrition, unsuitable abdominal settings, and steroids’ previous use. Using vedolizumab perioperatively seems safe. Nevertheless, a definitive relationship from the available data is controversial. Personalized, multidisciplinary evaluations and decisions should be made for each case independently, adjusting the surgical plan regarding the involved risk factors.

scholarly journals Effect of Originator Infliximab Treatment on Disease-Related Hospitalizations, Work Productivity and Activity Impairment, and Health Resource Utilization in Patients with Crohn’s Disease in a Real-Life Setting: Results of a Prospective Multicenter Study in Germany

2020 ◽  
pp. 1-13
Author(s):  
Niels Teich ◽  
Michael Bläker ◽  
Frank Holtkamp-Endemann ◽  
Eric Jörgensen ◽  
Andreas Stallmach ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Multicenter Study ◽  
Work Productivity ◽  
Infliximab Treatment ◽  
Prospective Multicenter Study ◽  
Hospitalization Rates ◽  
The Mean

<b><i>Introduction:</i></b> Infliximab (IFX) therapy is efficacious for inducing and maintaining symptomatic remission in patients with Crohn’s disease (CD), but whether this benefit results in reduced hospitalization rates and therefore may improve patients’ quality of life in an economically sensible way is conflicting so far. <b><i>Methods:</i></b> We conducted a noninterventional, multicenter, open-label, prospective study to evaluate the effect of originator IFX treatment on patient-reported outcomes and disease-related hospitalizations in adult CD patients in Germany treated for the first time with IFX according to label. <b><i>Results:</i></b> Two hundred and ninety-four patients were included in the study. We observed a statistically significant reduction in the number of CD-related hospitalizations from the year before baseline (mean 1.00 per patient, SD ± 0.93) to the mean value of the 1st (0.62, SD ± 0.95) and 2nd year (0.32, SD ± 0.75) of the observation period (<i>p</i> &#x3c; 0.0001). After 3 months of IFX therapy, work productivity and activity increased by an average of 12.6 and 17.1%, respectively. Patient’s clinical outcome was markedly improved as the total CD activity index (CDAI) sum score continuously decreased from baseline to month 24 and the mean score of the total inflammatory bowel disease questionnaire (IBDQ) changed substantially from 141 at baseline to 172 after 24 months of IFX treatment. Additionally, the number of work incapacity days declined. Recently, no new safety issues of IFX have been identified. <b><i>Conclusion:</i></b> In this large, prospective, multicenter study on disease-related hospitalization rates, work productivity, capacity for daily activities, and HRQoL in patients with CD, IFX significantly reduces their hospitalization rates and improves work productivity, daily activity, and quality of life over 24 months.

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.

Mycobacterial infection influences bone biomarker levels in patients with Crohn’s disease

2018 ◽  
Vol 96 (7) ◽  
pp. 662-667 ◽  
Author(s):  
Amna Naser ◽  
Ahmad Qasem ◽  
Saleh A. Naser
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Mycobacterium Avium ◽  
Disease Model ◽  
Mycobacterial Infection ◽  
Undercarboxylated Osteocalcin ◽  
Healthy Cattle ◽  
The Mean ◽  
Mycobacterium Avium Subsp Paratuberculosis ◽  
Active Inflammation

Patients with Crohn’s disease (CD) have higher risk for osteoporosis following decreased level of osteocalcin. We hypothesize that active inflammation following Mycobacterium avium subsp. paratuberculosis (MAP) infection results in elevation of undercarboxylated osteocalcin (ucOC) and downregulation of active osteocalcin in CD patients and cow-disease model (Johne’s disease). In this study, we measured ucOC, active osteocalcin, and calcium levels in sera from 42 cattle (21 infected with MAP and 21 healthy cattle), 18 CD patients, and 20 controls. The level of ucOC in MAP+ bovine samples was higher than that in MAP− controls (318 ± 57.2 nmol/mL vs. 289 ± 95.8 nmol/mL, P > 0.05). Consequently, mean calcium level in bovine MAP+ was significantly higher than that in bovine-MAP− samples (9.98 ± 0.998 mg/dL vs. 7.65 ± 2.12 mg/dL, P < 0.05). Also, the level of ucOC was higher in CD-MAP+ than in CD-MAP− (561 ± 23.7 nmol/mL vs. 285 ± 19.6 nmol/mL, P < 0.05). Interestingly, the mean osteocalcin level in MAP+ bovine was lower than that in MAP− bovine (797 ± 162 pg/mL vs. 1190 ± 43 pg/mL) and it was lower in CD-MAP+ than in CD-MAP− infection (1.89 ± 0.184 ng/mL vs. 2.19 ± 0.763 ng/mL) (P < 0.05). The correlation between MAP infection and elevation of sera ucOC, reduction of active osteocalcin and increased calcium supports MAP infection role in CD and complications with osteoporosis.

scholarly journals Capsule Retentions and Incomplete Capsule Endoscopy Examinations: An Analysis of 2300 Examinations

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Charlotte M. Höög ◽  
Lars-Åke Bark ◽  
Juan Arkani ◽  
Jacob Gorsetman ◽  
Olle Broström ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Male Gender ◽  
Large Series ◽  
Older Age ◽  
Safe Procedure ◽  
Capsule Retention

Aim. To evaluate capsule endoscopy in terms of incomplete examinations and capsule retentions and to find risk factors for these events.Material and Methods. This retrospective and consecutive study includes data from 2300 capsule enteroscopy examinations, performed at four different hospitals in Stockholm, Sweden from 2003 to 2009.Results. The frequency of incomplete examinations was 20%. Older age, male gender, suspected, and known Crohn's disease were risk factors for an incomplete examination. The PillCam capsule had the highest rate of completed examinations. Capsule retention occurred in 1.3% (). Risk factors for capsule retention were known Crohn's disease and suspected tumor. Complications of capsule retention were acute obstructive symptoms in six patients and one death related to complications after acute surgical capsule retrieval.Conclusion: Capsule endoscopy is considered a safe procedure, although obstructive symptoms and serious complications due to capsule retention can be found in a large series of patients.

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