Risk Factors for Repetitive Ileocolic Resection in Patients with Crohnʼs Disease

Manser, Christine N.; Frei, Pascal; Grandinetti, Tanja; Biedermann, Luc; Mwinyi, Jessica; Vavricka, Stephan R.; Schoepfer, Alain; Fried, Michael; Rogler, Gerhard

doi:10.1097/mib.0000000000000123

Cited by 32 publications

(10 citation statements)

References 42 publications

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“…There was no difference in the proportion of Non-IBD (n=32) and CD (n=36) samples that passed quality control ( P =.4747 by Fisher’s exact test). The demographic data for these CD subjects were comparable to the spectrum of data previously reported 23, 24 (Table S1). The average age at the time of surgery was significantly different between the Non-IBD and CD groups (Table S1); however, no significant differences in transcript abundances were identified within either diagnosis group based on this variable.…”

Section: Resultssupporting

confidence: 79%

Abnormal Small Intestinal Epithelial Microvilli in Patients With Crohn's Disease

VanDussen¹,

Stojmirović

et al. 2018

Gastroenterology

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In a transcriptome analysis of formalin-fixed and paraffin-embedded ileal tissues from patients with CD and controls, we associated transcriptional alterations with histologic alterations, such as differences in microvilli length. Decreased microvilli length and decreased expression of the microvilli gene set might contribute to epithelial malfunction and the chronic and progressive disease course in patients with CD.

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Section: Resultssupporting

confidence: 79%

Abnormal Small Intestinal Epithelial Microvilli in Patients With Crohn's Disease

VanDussen¹,

Stojmirović

et al. 2018

Gastroenterology

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“…Small bowel involvement negatively affects the long-term outcome of CD but is less associated with C-reactive protein and fecal calprotectin[3–6]. Ileal involvement in patients with CD is a significant risk factor[7, 8].…”

Section: Introductionmentioning

confidence: 99%

Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

et al. 2019

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Background/aims The small bowel is affected in more than half of patients with Crohn’s disease (CD) at the time of diagnosis, and small bowel involvement has a negative impact on the long-term outcome. Many patients reportedly have active lesions in the small intestine even in patients in clinical remission. This study was performed to compare findings of magnetic resonance enterography (MRE) and ileocolonoscopy. Methods A single-center retrospective study was conducted in 50 patients (60 imaging series) with CD, for whom MRE was additionally performed during the bowel preparation for subsequent ileocolonoscopy. Endoscopic remission was defined as a Simple Endoscopic Score for CD (SES-CD) of <5. MRE remission was defined as a Magnetic Resonance Index of Activity (MaRIA) score of <50. The time to treatment escalation was assessed by the log-rank test. Results Importantly, 7 of 29 patients (24.1%) with endoscopic remission had a MaRIA score of ≥50. Both SES-CD and MaRIA correlated with the need for treatment escalation ( P = 0.025, P = 0.009, respectively). MRE predicted the need for treatment escalation even in patients with endoscopic remission. Although no correlation was present between SES-CD and MaRIA score in patients with structuring/penetrating disease, or insufficient ileal insertion (<10cm), a high MaRIA score still correlated with the need for treatment escalation in stricturing or penetrating disease ( P = 0.0306). Conclusions The MaRIA score predicts the need for treatment escalation even in patients with endoscopic remission, indicating that addition of MRE to conventional ileocolonoscopy alone can be a useful, noninvasive tool for monitoring CD especially in stricturing or penetrating disease.

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“…According to the authors of the former study, this could be partially explained by the small number of patients recruited (n=127), including only 15% smokers. As for the latter, this result could be explained by the lack of 23% and 16% of smoking data at diagnosis and follow up respectively [ 43 , 44 ].…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…It has been evaluated in several studies, but outcomes are conflicting. Searching the literature, we found studies demonstrating either male [ 49 ] or female [ 50 ] sex as a predictive factor for POR, whereas the majority of authors found no differences in recurrence rates [ 43 , 44 , 51 , 52 ].…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…A recent study by Manser et al , collecting data from 305 patients, demonstrated that an ileal location of CD (Montreal-L1) is a predictive factor (OR 2.42, 95%CI 1.02-5.78, P=0.05) for a second ileocolonic resection [ 44 ]. A study of 280 patients in the John Radcliffe Hospital, Oxford, UK, concluded that patients with ileal disease had significantly higher POR rates compared to patients with ileocolonic (Montreal-L2) or colonic disease (Montreal-L3) [ 63 ].…”

Section: Disease-related Factorsmentioning

confidence: 99%

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Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors

Gklavas

Dellaportas

Papaconstantinou

2017

aog

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Intestinal resection for Crohn’s disease is not curative and postoperative recurrence rates remain high. Early detection of indices associated with recurrence and risk stratification are fundamental for the postoperative management of patients. Early endoscopy at 6-12 months is the “gold standard” procedure, whereas other modalities such as fecal calprotectin and imaging techniques can contribute to the diagnosis of recurrence. The purpose of this review is to summarize current data regarding risk factors correlated with postoperative relapse. Smoking is a well-established, modifiable risk factor. There are sufficient data that correlate penetrating disease, perianal involvement, extensive resections, prior surgery, histological features (plexitis and granulomas), and improper management after resection with high rates for recurrence. The literature provides conflicting data for other possible predictors, such as age, sex, family history of inflammatory bowel disease, location of disease, strictureplasties, blood transfusions, and postoperative complications, necessitating further evidence. On the other hand, surgical factors such as anastomotic configuration, open or laparoscopic approach, and microscopic disease at specimen margins when macroscopic disease is resected, seem not to be related with an increased risk of recurrence. Further recognition of histological features as well as gene-related factors are promising fields for research.

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Risk Factors for Repetitive Ileocolic Resection in Patients with Crohnʼs Disease

Abstract: Immunomodulators have a protective impact regarding surgical recurrence after ICR. In contrast, ileal disease location constitutes a significant risk factor for a second ICR.

Cited by 32 publications

References 42 publications

Abnormal Small Intestinal Epithelial Microvilli in Patients With Crohn's Disease

Abnormal Small Intestinal Epithelial Microvilli in Patients With Crohn's Disease

Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors

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