Causes and Prognosis of Intestinal Failure in Crohn’s Disease: An 18-year Experience From a National Centre

Soop, Mattias; Khan, Haroon; Nixon, Emma; Teubner, Antje; Abraham, Arun; Carlson, Gordon L; Lal, Simon

doi:10.1093/ecco-jcc/jjaa060

Cited by 13 publications

(10 citation statements)

References 44 publications

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“…The peri-/post-operative events that most frequently lead to CIF in CD have been purported to be multiple resections, enterocutaneous fistulation, and malabsorption with multiple resections, leading to cumulative loss of the small bowel. However, Soop et al [ 21 ], in a longitudinal cohort study of 121 patients referred to a national intestinal failure unit from 2000 to 2018 who were diagnosed with CD and subsequently treated with PN for at least 12 mo, identified septic complications following abdominal surgery to be the most frequent event leading directly to CIF.…”

Section: Epidemiologymentioning

confidence: 99%

Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Aksan¹,

Farrag²,

Blumenstein³

et al. 2021

WJG

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Chronic intestinal failure (CIF) is a rare but feared complication of Crohn’s disease. Depending on the remaining length of the small intestine, the affected intestinal segment, and the residual bowel function, CIF can result in a wide spectrum of symptoms, from single micronutrient malabsorption to complete intestinal failure. Management of CIF has improved significantly in recent years. Advances in home-based parenteral nutrition, in particular, have translated into increased survival and improved quality of life. Nevertheless, 60% of patients are permanently reliant on parenteral nutrition. Encouraging results with new drugs such as teduglutide have added a new dimension to CIF therapy. The outcomes of patients with CIF could be greatly improved by more effective prevention, understanding, and treatment. In complex cases, the care of patients with CIF requires a multidisciplinary approach involving not only physicians but also dietitians and nurses to provide optimal intestinal rehabilitation, nutritional support, and an improved quality of life. Here, we summarize current literature on CIF and short bowel syndrome, encompassing epidemiology, pathophysiology, and advances in surgical and medical management, and elucidate advances in the understanding and therapy of CIF-related complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.

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Section: Epidemiologymentioning

confidence: 99%

Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Aksan¹,

Farrag²,

Blumenstein³

et al. 2021

WJG

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“…Abdominal penetrating CD may range in complexity from an abdominal inflammatory mass ( 8 ), free perforation, entero-enteric or e.g., entero-cystic to enterocutaneous fistulas (ECF), with or without intestinal failure (IF) ( 33 , 34 ).…”

Section: Abdominal Penetrating Crohn's Diseasementioning

confidence: 99%

“…The other major cause of penetrating CD is due to surgical or endoscopic complications ( 47 – 51 ). The most advanced form of penetrating CD developing IF is related to surgical complications in 83–88% and only 12–17% due to the disease itself ( 33 , 34 ). Most patients with CD and post-operative complications will, however, not develop IF but rather intra-abdominal septic complications (IASC), like abscesses and/or anastomotic fistulas, occurring in about 5–10% ( 47 – 50 ).…”

Section: Abdominal Penetrating Crohn's Diseasementioning

confidence: 99%

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Surgical Planning in Penetrating Abdominal Crohn's Disease

2022

Self Cite

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Crohn's disease (CD) is increasing globally, and the disease location and behavior are changing toward more colonic as well as inflammatory behavior. Surgery was previously mainly performed due to ileal/ileocaecal location and stricturing behavior, why many anticipate the surgical load to decrease. There are, however, the same time data showing an increasing complexity among patients at the time of surgery with an increasing number of patients with the abdominal perforating disease, induced by the disease itself, at the time of surgery and thus a more complex surgery as well as the post-operative outcome. The other major cause of abdominal penetrating CD is secondary to surgical complications, e.g., anastomotic dehiscence or inadvertent enterotomies. To improve the care for patients with penetrating abdominal CD in general, and in the peri-operative phase in particular, the use of multidisciplinary team discussions is essential. In this study, we will try to give an overview of penetrating abdominal CD today and how this situation may be handled. Proper surgical planning will decrease the risk of surgically induced penetrating disease and improve the outcome when penetrating disease is already established. It is important to evaluate patients prior to surgery and optimize them with enteral nutrition (or parenteral if enteral nutrition is ineffective) and treat abdominal sepsis with drainage and antibiotics.

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“…In a European cross-sectional survey on patients on home parenteral nutrition for IF due to benign disease, short bowel syndrome was the main mechanism accounting for about 75% of the cases among adults, whereof 29% were patients with CD 293 . In a report from a specialised intestinal failure unit in UK in 2020, it was stated that IF develops in CD primarily as a result of complications of surgical treatment with the majority having been through only one or two planned surgical procedures 294 . In an earlier study from the same unit three quarters of the patients with surgically induced IF consisted of patients with CD who had been through multiple unplanned laparotomies to control postoperative intra-abdominal sepsis 295 .…”

Section: Surgical Recurrence and Risk Of Intestinal Failure / Short Bowel Syndromementioning

confidence: 99%

Surgery and stomas in Crohn's disease

Kalman

2021

Linköping University Medical Dissertations

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This study investigates the evolution of abdominal surgery in treatment of Crohn´s disease (CD) in the era of immunomodulatory drugs and biologicals. It concerns risk of abdominal surgery overall and sub-categories of abdominal surgery, risk of repeat surgery and factors that affect this risk, and risk of getting a stoma. Surgical recurrence is a major clinical problem as repeat procedures are more complex and expose the patients to a higher medical risk both in conjunction with surgery and afterwards. Updated information on abdominal surgery for CD will be of use when making decisions about medical vs surgical interventions.

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Causes and Prognosis of Intestinal Failure in Crohn’s Disease: An 18-year Experience From a National Centre

Abstract: Abstract Background and Aims Intestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported. Methods Cons… Show more

Cited by 13 publications

References 44 publications

Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Chronic intestinal failure and short bowel syndrome in Crohn’s disease

Surgical Planning in Penetrating Abdominal Crohn's Disease

Surgery and stomas in Crohn's disease

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