Long-term incidence and characteristics of intestinal failure in Crohn’s disease: a multicenter study

Watanabe, Kazuhiro; Sasaki, Iwao; Fukushima, Kouhei; Futami, Kitaro; Ikeuchi, Hiroki; Sugita, Akira; Nezu, Riichiro; Mizushima, Tsunekazu; Kameoka, Shingo; Kusunoki, Masato; Yoshioka, Kazuhiko; Funayama, Yuji; Watanabe, Toshiaki; Fujii, Hisao; Watanabe, Mamoru

doi:10.1007/s00535-013-0797-y

Cited by 52 publications

(33 citation statements)

References 29 publications

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“…There is strong evidence that strict aseptic handling protocols lead to very low rates of CRBSI [15] . CRBSI was the most frequent complication reported by Watanabe et al [14] in CD patients on TPN, occurring in 58 patients (57%) during a mean of 7.9 years of follow-up and responsible for 4 deaths. A study in the United Kingdom found that 8.8% of deaths were related to IFALD and were more common in patients without a continuous colon and with shorter small bowel segments [15] .…”

Section: Total Parenteral Nutritionmentioning

confidence: 99%

“…Surgical complications requiring extensive additional resections, initial diagnostic errors, and insufficient and late prescription of immunosuppression therapy may also contribute to IF development [9,12] . Not much data are available on the longterm incidence of IF in CD patients, but a study from Japan [14] reported that the cumulative risk of IF after initial surgery was 0.8% at 5 years, 3.6% at 10 years, 6.1% at 15 years, and 8.5% at 20 years. The mean number of intestinal surgeries was 3.3 per patient with a mean SB remnant of 163 cm.…”

Section: Intestinal Failurementioning

confidence: 99%

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Crohn's Disease and Intestinal Transplantation

Drastich

Oliverius

2017

Dig Dis

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Background: Most patients with Crohn's disease (CD) require one or more operations during their lifetime. Repeated resections and surgical complications may result in short gut in a subset of patients, typically those with extensive small bowel disease or a penetrating CD phenotype. The effects of short bowel syndrome (SBS) can range in seriousness from mild to life-threatening advanced intestinal failure. Worldwide, CD is the second leading indication for intestinal transplantation (ITx) in SBS, but the overall incidence of ITx is quite low. Key Messages: Currently, total parenteral nutrition (TPN) is the preferred treatment option for patients with SBS because of its superior survival outcome. However, TPN can fail from loss of venous access due to catheter-associated thromboses, recurrent catheter-related blood stream infections, or intestinal-failure-associated liver dysfunction. Three types of transplantations are available for CD patients - small bowel alone, liver plus small bowel and multivisceral, which includes other intra-abdominal organs. An abdominal wall transplant is required in case of abdominal wall defects or lack of free intra-abdominal space. The current 5-year survival rate of 54% following ITx of the isolated small bowel appears worse than that associated with TPN. However, outcomes are substantially improving because of surgical and technical advances and progress in medical therapy. On the other hand, ITx carries the risk of both complications (e.g., rejection, infections, and post transplant lymphoproliferative disorders) and adverse events associated with immunosuppression. CD recurrence has been reported in a few patients, but this primarily histologic recurrence might not be of great clinical importance. Conclusions: ITx has become a well-established treatment for those who fail on TPN and who have life-threatening complications. Fortunately, it concerns only a small proportion of CD patients, but it does offer reasonable survival and quality of life. Primary management of patients with small bowel failure should be provided by a center experienced in medical intestinal rehabilitation, nutrition, and transplantation of other solid organs.

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Section: Total Parenteral Nutritionmentioning

confidence: 99%

Section: Intestinal Failurementioning

confidence: 99%

Crohn's Disease and Intestinal Transplantation

Drastich

Oliverius

2017

Dig Dis

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“…With scarcity of relevant published data, a recent retrospective long-term multicenter Japanese study demonstrated a cumulative risk of IF of 0.8% at 5 years after the first small bowel resection with 3.6% at 10 years, 6.1% at 15 years, and 8.5% at 20 years. 4 In this unique cohort, the cumulative risk of IF-related death was 1.1% at 3 years, 3.7% at 5 years, and 8.9% at 10 years. 4 With better understanding of the disease immunobiology, and introduction of novel therapeutic modalities, the risk of CDassociated IF could be potentially reduced.…”

Section: Intestinal Failurementioning

confidence: 98%

“…4,11 In addition, the disease has become a significant global healthcare problem with increased prevalence, particularly in the developing countries. 12 According to recent epidemiologic studies, the highest annual incidence of CD per 100,000 person-years is 12.7 in Europe, 5.0 in Asia and the Middle East, and 20.2 in North America.…”

Section: Intestinal Failurementioning

confidence: 99%

“…1 Despite recent therapeutic advances, the risk of relapse, particularly with Crohn's disease (CD), continues to be high with anticipated cumulative structural damage, development of complex abdominal pathology, and ultimate loss of nutritional autonomy. [2][3][4] The most common cause of CDassociated intestinal failure (IF) is development of short bowel syndrome (SBS) due to multiple resections with major loss of enterocyte and colocyte absorptive cell mass. Other precipitating factors include multiple strictures and complex enteric fistulae.…”

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confidence: 99%

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Management of Crohnʼs Disease in the New Era of Gut Rehabilitation and Intestinal Transplantation

Nyabanga

Kochhar

Costa

et al. 2016

Inflammatory Bowel Diseases

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Despite recent therapeutic advances, patients with Crohn's disease (CD) continue to experience high recurrence with cumulative structural damage and ultimate loss of nutritional autonomy. With short bowel syndrome, strictures, and enteric fistulae being the underlying pathology, CD is the second common indication for home parenteral nutrition (HPN). With development of intestinal failure, nutritional management including HPN is required as a rescue therapy. Unfortunately, some patients do not escape the HPN-associated complications. Therefore, the concept of gut rehabilitation has evolved as part of the algorithmic management of these patients, with transplantation being the ultimate life-saving therapy. With type 2 intestinal failure, comprehensive rehabilitative measures including nutritional care, pharmacologic manipulation, autologous reconstruction, and bowel lengthening is often successful, particularly in patients with quiescent disease. With type 3 intestinal failure, transplantation is the only life-saving treatment for patients with HPN failure and intractable disease. With CD being the second common indication for transplantation in adults, survival outcome continues to improve because of surgical innovation, novel immunosuppression, and better postoperative care. Despite being a rescue therapy, the procedure has achieved survival rates similar to other solid organs, and comparable to those who continue to receive HPN therapy. With similar technical, immunologic, and infectious complications, survival is similar in the CD and non-CD recipients. Full nutritional autonomy is achievable in most survivors with better quality of life and long-term cost-effectiveness. CD recurrence is rare with no impact on graft function. Further progress is anticipated with new insights into the pathogenesis of CD and mechanisms of transplant tolerance.

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Colonoscopy-guided therapy for the prevention of post-operative recurrence of Crohn’s disease

Cândia

Ibáñez

Nguyen

2016

Cochrane Database of Systematic Reviews

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Long-term incidence and characteristics of intestinal failure in Crohn’s disease: a multicenter study

Abstract: The occurrence of IF and IF-related death in CD patients is not rare over the long term. There is a pressing need to develop strategies for the prevention and management of IF.

Cited by 52 publications

References 29 publications

Crohn's Disease and Intestinal Transplantation

Crohn's Disease and Intestinal Transplantation

Management of Crohnʼs Disease in the New Era of Gut Rehabilitation and Intestinal Transplantation

Colonoscopy-guided therapy for the prevention of post-operative recurrence of Crohn’s disease

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