Predictors of surgical intervention in patients with inflammatory bowel disease (two-center study)

Abstract

Background Sixty percent of Crohn’s disease (CD) patients require intestinal resection, and 20% of ulcerative colitis (UC) patients undergo proctocolectomy for medically refractory disease. Scarcity of literature about predictors for surgical intervention in inflammatory bowel disease (IBD) encouraged the conduction of this study to assess risk factors for surgical intervention in IBD patients. Results This cohort study included 80 Egyptian inflammatory bowel disease patients recruited from two medical centers. Patients were classified into two groups, 40 patients each, according to their need for surgical intervention to control inflammatory bowel disease. The two groups were compared regarding age of onset, type and location of disease, smoking, extraintestinal manifestations, perianal disease, granuloma, severity scores, stool calprotectin, complete blood count, erythrocyte sedimentation rate, C-reactive protein, and serum albumin at diagnosis for Crohn’s disease patients. Twelve ulcerative colitis and 28 Crohn’s disease patients required surgical intervention in the form of total colectomy (30%), fistulectomy (32.5%), resection anastomosis (17.5%) or abscess drainage (20%). Perianal disease, smoking, and disease severity scores showed high significant differences (P value < 0.001); disease type and presence of granuloma showed statistically significant difference (P value < 0.05) between both groups. But, patient age at onset, location of the disease or extraintestinal manifestation had no statistical significance (P value > 0.5). Surgical interventions were more likely to be needed in patients with higher stool calprotectin level, C-reactive protein, erythrocyte sedimentation rate, and lower serum albumin for Crohn’s disease patients (P value < 0.001 for each). Conclusion Smoking, perianal disease, higher severity scores, stool calprotectin, C-reactive protein, and erythrocyte sedimentation rate levels are predictors of surgical treatment.

Predictors of non-response to ongoing conservative therapy in patients with inflammatory bowel disease

“…Crohn's disease and the presence of granulomas were more frequently observed in the surgical group (P value <0.05). Conversely, factors such as the age of disease onset, the location of the disease, and the presence of extraintestinal manifestations did not show any statistically significant differences when comparing both patient groups (P value >0.5) [39].…”

“…Additionally, CD patients in the surgical group had lower serum albumin levels at the onset of the disease compared to their non-surgical counterparts (P value <0.001). However, there were no significant differences observed in terms of complete blood count (CBC) parameters between the two groups, as indicated in [39] (Table 4).…”

“…Another rather interesting study was carried out by Egyptian colleagues [39], which studied predictors of surgery in patients with inflammatory bowel disease.…”

“…Extraintestinal symptoms, such as uveitis, arthritis, and arthralgia, were present in 61.3% of cases, and 37.5% of patients had perianal issues, with 27.5% showing granulomas in their histopathological reports. The mean Clinical Disease Activity Index (CDAI) score for Crohn's disease (CD) patients was 298.45 ± 83.3, and for those with ulcerative colitis (UC), the mean Mayo score was 8.65 ± 1.9 [39].…”

“…Cutoff values, sensitivity, and specificity of significant scores and laboratory parameters are attached in [39] [39].…”