Classification of the sequelae of bowel resection for Crohn's disease

Abstract

A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0.64 and 0.90, and 0.60 and 0.99 respectively in the retrospective series; values were 0.80 and 0.71, and 0.25 and 1.00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.

Natural history of Crohnʼs disease

“…The postsurgical handicap index (PSHI) was developed to predict the functional consequences of intestinal resection for CD. 19 This index is calculated from operative records, taking into account the location and the extent of intestinal resection. An index score equal or superior to 20 has a high predictive value of diarrhea following intestinal resection.…”

Endpoints for clinical trials evaluating disease modification and structural damage in adults with Crohnʼs disease

“…One early version of a bowel damage score demonstrated good correlation with fecal fat and fecal weight. 50 …”

Diffuse Small Bowel Crohn's Disease Treated with Side-to-Side Isoperistaltic Strictureplasty: Report of Two Cases and Description of a Variation of the Original Technique

“…7 The incidence of short bowel syndrome (SBS) in Crohn's disease ranges from 1.1% to 1.5%, and 2.5% of patients suffer from chronic malnutrition. 8 SBS becomes symptomatic when less than 60 cm of small intestine with the ileocecal valve or less than 120 cm without the ileocecal valve remains after a surgical resection. 9 The ileocecal valve is a crucial factor for SBS because it represents an anatomic barrier against colonic bacterial reflux and at the same time avoids rapid colonic influx with an improvement in nutrient absorption.…”