Post-operative prevention and monitoring of Crohn’s disease recurrence

Lee, Eunah; Cantrell, Sarah; Shen, Bo; Faye, Adam S.

doi:10.1093/gastro/goac070

Cited by 13 publications

(14 citation statements)

References 88 publications

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“…These factors reflect the chronic nature, severity, and activity of CD, respectively. Previous studies have also reported similar results [ 9–11 , 25 ]. These factors may be used as indicators for initiating more aggressive treatment or closer monitoring in CD patients.…”

Section: Discussionsupporting

confidence: 85%

A novel location classification system for Crohn’s disease based on small bowel involvement: a better predictor of disease progression

Guo,

Tang,

Qin

et al. 2023

Gastroenterology Report

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Background Small bowel involvement is related to poor prognosis in Crohn’s disease (CD), which may be a potential marker to stratify patients with a high risk of progression. This study aimed to establish a novel location classification system for CD and to develop a predictive model for disease progression. Methods Consecutive patients with non-stricturing/non-penetrating CD were retrospectively included in the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, P. R. China) between January 2012 and January 2018. Patients were classified into two groups according to disease location: small bowel involvement group and isolated colon group. The primary outcome was disease progression to stricturing or penetrating phenotypes. Progression-free survival was estimated using Cox proportional hazards regression analysis and Kaplan–Meier method. Results A total of 463 patients were analysed, with a median follow-up time of 55.3 months. Patients with small bowel involvement had a higher risk of disease progression than those with isolated colon disease (hazard ratio = 1.998, P = 0.007), while no differences were found between Montreal location classification and disease progression. Median progression-free survival was higher in the isolated colon group than in the small bowel involvement group (84.5 vs 77.3 months, P = 0.006). Four independent factors associated with disease progression were identified: small bowel involvement, duration of onset of >1 year, deep mucosal ulcer, and C-reactive protein levels of ≥10 mg/L (all P < 0.05). The nomogram model based on these factors showed good performance in predicting disease progression, with a C-index of 0.746 (95% confidence interval, 0.707–0.785). Conclusions Classifying CD based on small bowel involvement and isolated colon was superior to the Montreal location classification for predicting disease progression.

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Section: Discussionsupporting

confidence: 85%

A novel location classification system for Crohn’s disease based on small bowel involvement: a better predictor of disease progression

Guo,

Tang,

Qin

et al. 2023

Gastroenterology Report

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“…Guidelines from the 2017 ACR/AAHKS recommend stopping Tofacitinib 7 d prior to surgery and resuming it 14 d after surgery. However, in urgent or emergent cases, surgery should not be delayed to avoid increased post-operative complications[ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

Mowlah,

Soldera

2023

World J Gastrointest Surg

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BACKGROUND Indications for surgery in inflammatory bowel disease (IBD) include treatment-refractory disease or severe complications such as obstruction, severe colitis, dysplasia, or neoplasia. Infectious complications following colorectal surgery in IBD are significant, particularly in high-risk patients. AIM To gather evidence on risk factors associated with increased post-operative infectious complications in IBD and explore management strategies to reduce morbidity and mortality. METHODS A systematic review adhering to PRISMA-P guidelines was conducted. MEDLINE (PubMed) and Cochrane Library databases were searched using specific keywords. Inclusion criteria encompassed studies involving patients with IBD undergoing abdominal surgery with infectious complications within 30 d postoperatively. Exclusion criteria included patients under 18 years and non-infectious complications. Selected papers were analyzed to identify factors contributing to post-operative infections. A narrative analysis was performed to provide evidence-based recommendations for management. The data were then extracted and assessed based on the Reference Citation Analysis (https://www.referencecitationanalysis.com/ ). RESULTS The initial database search yielded 1800 articles, with 330 articles undergoing full-text review. After excluding duplicates and irrelevant papers, 35 articles were included for analysis. Risk factors for post-operative complications in patients with IBD included hypoalbuminemia, malnutrition, preoperative abscess, and obesity. Perioperative blood transfusion was associated with increased infectious complications. Medications such as 5-aminosalicylates and immunomodulators did not increase post-operative complications. Corticosteroids were associated with an increased risk of complications. Ustekinumab and vedolizumab showed similar rates of infectious complications compared to other treatments. The impact of minimally invasive surgery on post-operative complications varied across studies. CONCLUSION In order to reduce post-operative infectious complications in patients with IBD, a comprehensive approach involving multiple disciplines is necessary.

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“…For example, packing the ileal pouch can lead to the emergence of acute and chronic forms of pouchitis[ 34 ]. In contrast, in CD, surgery does not exclude the reactivation of the disease at the perianastomotic site or its emergence at other gastrointestinal sites[ 35 ].…”

Section: Evidence Review: What Are the Responses Of Chatgpt?mentioning

confidence: 99%

“…Q10 O1 did not comment and referred the discussion to the physician. Q10 O2,3, on the other hand, correctly exhibited some of the factors based on which one may decide to avoid biological therapy after initial CD surgery ( e.g., extent of surgery, risks and benefits, patient preference)[ 35 ].…”

Section: Evidence Review: What Are the Responses Of Chatgpt?mentioning

confidence: 99%

May ChatGPT be a tool producing medical information for common inflammatory bowel disease patients’ questions? An evidence-controlled analysis

Gravina,

Pellegrino,

Cipullo

et al. 2024

World J Gastroenterol

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Artificial intelligence is increasingly entering everyday healthcare. Large language model (LLM) systems such as Chat Generative Pre-trained Transformer (ChatGPT) have become potentially accessible to everyone, including patients with inflammatory bowel diseases (IBD). However, significant ethical issues and pitfalls exist in innovative LLM tools. The hype generated by such systems may lead to unweighted patient trust in these systems. Therefore, it is necessary to understand whether LLMs (trendy ones, such as ChatGPT) can produce plausible medical information (MI) for patients. This review examined ChatGPT’s potential to provide MI regarding questions commonly addressed by patients with IBD to their gastroenterologists. From the review of the outputs provided by ChatGPT, this tool showed some attractive potential while having significant limitations in updating and detailing information and providing inaccurate information in some cases. Further studies and refinement of the ChatGPT, possibly aligning the outputs with the leading medical evidence provided by reliable databases, are needed.

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Post-operative prevention and monitoring of Crohn’s disease recurrence

Cited by 13 publications

References 88 publications

A novel location classification system for Crohn’s disease based on small bowel involvement: a better predictor of disease progression

A novel location classification system for Crohn’s disease based on small bowel involvement: a better predictor of disease progression

Risk and management of post-operative infectious complications in inflammatory bowel disease: A systematic review

May ChatGPT be a tool producing medical information for common inflammatory bowel disease patients’ questions? An evidence-controlled analysis

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