Post-operative recurrence in Crohn's disease. Critical analysis of potential risk factors. An update

Fornaro, Rosario; Caratto, Elisa; Caratto, Michela; Fornaro, Francesco; Colella, Giuseppe; Frascio, Marco; Sticchi, Camilla

doi:10.1016/j.surge.2015.04.002

Cited by 33 publications

(21 citation statements)

References 136 publications

(301 reference statements)

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“…In addition, a recursive search identified other potentially eligible studies among the bibliographies of selected articles. Finally, we searched the bibliographies of previous systematic reviews in this area . Eligibility was judged by two independent investigators with any disagreements resolved by a third investigator.…”

Section: Methodsmentioning

confidence: 99%

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Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

Gracie

Ford

2016

Aliment Pharmacol Ther

140

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Summary Background Tobacco smoking is a well‐established risk factor for the development of Crohn's disease, and this may lead to a more complicated disease course. However, recent evidence suggests that many patients with Crohn's disease are unaware of this fact. Aim To perform a systematic review and meta‐analysis of the effects of smoking on disease course in Crohn's disease. Methods A search of MEDLINE, EMBASE and EMBASE classic was carried out (up to July 2015) to identify observational studies reporting data on smoking and rates of surgery or flares of disease activity in patients with Crohn's disease. Dichotomous data were pooled to obtain odds ratios (ORs) for flares of disease activity or need for surgery, with 95% confidence intervals (CIs). Results The search identified 33 eligible studies. Compared with nonsmokers, smokers had increased odds of flare of disease activity (OR, 1.56; 95% CI, 1.21–2.01), flare after surgery (OR, 1.97; 95% CI, 1.36–2.85), need for first surgery (OR, 1.68; 95% CI, 1.33–2.12) and need for second surgery (OR, 2.17; 95% CI, 1.63–2.89). The odds of these outcomes among ex‐smokers diminished upon smoking cessation, with ORs comparable to those among nonsmokers and, in the case of flare or second surgery, significantly lower than smokers. Conclusions Smokers with Crohn's disease have a more complicated disease course than nonsmokers, and quitting smoking may ameliorate this. Patients should be reminded of the detrimental effects of smoking on the course of their disease, and smoking cessation advice should be provided to reduce disease burden and costs in these patients.

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Section: Methodsmentioning

confidence: 99%

“…Finally, we searched the bibliographies of previous systematic reviews in this area. [18][19][20][21][22][23][24][25] Eligibility was judged by two independent investigators with any disagreements resolved by a third investigator.…”

Section: Methodsmentioning

confidence: 99%

Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

Gracie

Ford

2016

Aliment Pharmacol Ther

140

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“…In CD one of the most frequent complications are fistulas, which can arise along the entire gastrointestinal tract, although in most cases they are perianal (54$), enteric (24$), or rectovaginal (9$). One-third of CD patients will have recurrent fistulas that are difficult to manage for both the clinician and the surgeon [4, 5, 6]. The chronic inflammatory process that characterizes this disease exposes CD patients to an increased risk of cancer [7]: they have a risk two to three times higher than the general population [4, 5, 6].…”

Section: Discussionmentioning

confidence: 99%

“…One-third of CD patients will have recurrent fistulas that are difficult to manage for both the clinician and the surgeon [4, 5, 6]. The chronic inflammatory process that characterizes this disease exposes CD patients to an increased risk of cancer [7]: they have a risk two to three times higher than the general population [4, 5, 6]. The different neoplastic transformations and the different types of tumors that may appear in patients with CD, especially at the colorectal level or at the level of an eventual anastomosis, are to date well documented and described in the literature, while there is a lack of information and of treated cases concerning the occurrence of cancer at the level of a fistula (the carcinoma rate is < 1$).…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma Arising from Perianal Fistulizing Crohn’s Disease

Fornaro

Frascio

Caratto

et al. 2018

Case Rep Gastroenterol

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Perianal fistula is a very debilitating event and a cause of morbidity in patients with Crohn’s disease (CD). Its malignant transformation is very rare with an incidence of around 0.004–0.7%. Presence of disease in the colon and rectum is the major risk factor for the development of a perianal fistula. In this report we show a case of adenocarcinoma arising from a perianal fistulizing CD. This type of tumor is highly aggressive, difficult to diagnose, and has a rather poor prognosis. The different neoplastic transformations and the different types of tumors that may appear in patients with CD, especially at the colorectal level or at the level of an eventual anastomosis, are to date well documented and described in the literature, while there is a lack of information and of treated cases concerning the occurrence of cancer at the level of a fistula. Due to the rarity of cases, we tried to identify the most frequent and important risk factors: sex, duration of disease, age at diagnosis, and the history of the fistula.

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“…16 Although there is no consensus on all the risk factors for early postoperative recurrence, it is generally agreed that previous surgery, extensive resection, penetrating disease, ileocolonic distribution, perianal involvement, young age at onset, and smoking all portend relatively poor prognosis. [61][62][63][64][65] Hence, patients in these risk strata may be the best candidates for early postoperative prophylaxis with predictive of a durable maintenance therapy response. [88][89][90] Low infliximab concentrations (<2.2 μg/mL) at week 14 of treatment have been shown to predict cessation of treatment owing to the development of anti-drug antibodies (ADAs) and loss of response.…”

Section: Postoperative Anti-tnf Prophylaxismentioning

confidence: 99%

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

Cohen

Sachar

2017

BMJ

113

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The treatment of inflammatory bowel disease (IBD)-ulcerative colitis (UC) and Crohn's disease (CD)-has evolved beyond surgery with the introduction of biologic agents, primarily antibodies against mediators of inflammation and cell attraction. Anti-tumor necrosis factor (TNF) agents have been the first line treatment for moderate to severe ulcerative colitis and Crohn's disease for more than 15 years. During that time much has been learnt about how best to use these agents. This review will assess the evidence on how to optimize the use of anti-TNF agents; when and how to start treatment; how to monitor treatment and when to de-escalate it; and the potential adverse effects of these drugs. New and emerging treatments such as anti-attractants, anti-interleukins, and Janus kinase (JAK) inhibitors will also be discussed.

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Post-operative recurrence in Crohn's disease. Critical analysis of potential risk factors. An update

Cited by 33 publications

References 136 publications

Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

Adenocarcinoma Arising from Perianal Fistulizing Crohn’s Disease

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

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