Natural History of Crohnʼs Disease Following Total Colectomy and End Ileostomy

Abstract

Background Crohn's disease (CD) requires surgical management in up to two-thirds of patients. Few studies have addressed the issue of ileal recurrence after colectomy and permanent ileostomy. The aims of our study were to assess the rate and predictors of postoperative recurrence of CD in patients with permanent ileostomy. Methods In a retrospective study from a tertiary referral center, we analyzed the natural history of CD patients who underwent total colectomy and permanent ileostomy. Our primary outcomes were (1) overall disease recurrence including luminal recurrence, perianal disease or peristomal lesions requiring therapy, and (2) luminal recurrence alone defined as endoscopic and clinical recurrence within the terminal ileum. We examined if patient characteristics predicted recurrence using multivariate Cox proportional hazard models. Results Our study included 73 CD patients followed for a mean of 28 months (range 0-168 months) after total colectomy and permanent ileostomy. Twenty patients had overall disease recurrence within 10 years after surgery, at rates of 15% and 50% 1 and 5 years. Rate of luminal recurrence was 8% and 35% at 1 and 5 years. Diagnosis at age less than 18 years (HR 2.94, 95% CI 1.14 – 7.62) and anti-TNF therapy prior to surgery (HR 4.75, 95% CI 1.25 – 18.13) were the only independent predictive factors for overall disease recurrence. Conclusions Up to one-third of CD patients have overall recurrence of disease after treatment with total colectomy and permanent ileostomy. There is need to develop algorithms for surveillance and management of this select subgroup of patients.

Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection

“…These results are consistent with previous studies that perianal disease was less common in late‐onset CD . Age of onset was considered as significant prognostic factor, that late‐onset CD was associated with better clinical outcome . In our study, we could observe the trend of decreased risk of reoperation as age of diagnosis went up, but it was not statistically significant.…”

Systematic review with meta‐analysis: faecal diversion for management of perianal Crohn's disease

“…We identified an additional unpublished study through personal communication with content experts, and hence, included a total of 16 studies in our meta‐analysis. The primary reasons for exclusion after full‐text review were: lack of data on long‐term efficacy of FD, specifically rates of restoration of bowel continuity (six studies), FD performed for colonic CD without severe perianal CD (seven studies), and reporting recurrence of CD after intended permanent ileostomy for colonic and/or perianal CD (five studies) . Figure shows the schematic diagram of study selection.…”

The Impact of Ostomy on Quality of Life and Functional Status of Crohnʼs Disease Patients

“…However, those with primarily colonic disease have higher chances of maintaining long term clinical remission after colectomy with a suggested advantage of ileostomy over anastomosis. 22,23 In a study by Bernell et al , the cumulative 10-year risk of a symptomatic recurrence after colectomy with ileorectal anastomosis was 58% compared to 24% after colectomy with ileostomy. 22 The outcome is likely different for patients requiring ostomy for other indications, particularly those with refractory perianal disease.…”