Clinical Factors Associated with the Development of Crohnʼs Disease in Inflammatory Bowel Disease-unclassified Patients Undergoing Ileal Pouch–anal Anastomosis

Koh, Sharon; Zaghiyan, Karen; Li, Quan‐Lin; Rabizadeh, Shervin; Melmed, Gil Y.; Targan, Stephan R.; Fleshner, Phillip

doi:10.1097/mib.0000000000000744

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…Another study about pediatric-onset IBDU showed that patients with a family history of CD and treatments including surgery, steroids, cyclosporine, anti-TNF and nutritional support were more likely to be diagnosed with CD [ 32 ]. Additionally, Sharon Z. Koh et al discovered that the only clinical factor related to CD reclassification after IPAA for IBDU was younger age at disease onset [ 33 ]. As our IBDU patients commonly present for medical evaluation during the intermediate phase, individualized treatment can be implemented based on the identified factors mentioned above before reaching the final differentiation.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of inflammatory bowel disease unclassified: a case-control study

Shao,

Zhao,

et al. 2024

BMC Gastroenterol

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Background Approximately 10-15% of inflammatory bowel disease (IBD) patients with overlapping features of ulcerative colitis (UC) and Crohn’s disease (CD) are termed as inflammatory bowel disease unclassified (IBDU). This study aimed to describe the clinical features of IBDU and evaluate the potential associated factors of reclassification. Methods The clinical data of 37 IBDU patients were retrospectively analyzed from November 2012 to November 2020. 74 UC and 74 CD patients were randomly selected and age- and sex-matched with the 37 IBDU patients. Clinical characteristics were compared between the three patient groups. Potential factors associated with the IBDU reclassification were evaluated. Results 60% of IBDU patients displayed rectal-sparing disease, and 70% of them displayed segmental disease. In comparison to UC and CD, the IBDU group demonstrated higher rates of gastrointestinal bleeding (32.4%), intestinal perforation (13.5%), spontaneous blood on endoscopy (51.4%), and progression (56.8%). The inflammation proceeded relatively slowly, manifesting as chronic alterations like pseudopolyps (78.4%) and haustra blunt or disappearance (56.8%). 60% of IBDU patients exhibited crypt abscess, and 16.7% of them exhibited fissuring ulcers or transmural lymphoid inflammation. The proportions of IBDU patients receiving immunosuppressants, surgery, and infliximab were basically the same as those of CD patients. During the 79 (66, 91) months of follow-up, 24.3% of IBDU patients were reclassified as UC, while 21.6% were reclassified as CD. The presence of intestinal hemorrhaging was associated with CD reclassification, while hypoalbuminemia was associated with UC reclassification. Conclusions IBDU may evolve into UC or CD during follow-up, and hemorrhage was associated with CD reclassification. Different from the other two groups, IBDU exhibited a more acute onset and a gradual progression. When an IBD patient presents with transmural inflammation or crypt abscess but lacks transmural lymphoid aggregates or fissuring ulcers, the diagnosis of IBDU should be considered.

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Section: Discussionmentioning

confidence: 99%

Clinical features of inflammatory bowel disease unclassified: a case-control study

Shao,

Zhao,

et al. 2024

BMC Gastroenterol

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“…Clinically, the only factor associated with the development of de novo CD after IPAA in IBD‐U is younger age at disease onset. [19] Biologically, patients diagnosed at a younger age or in childhood may be exposed or respond differently to various microbial antigens as compared to adults, resulting in a more persistent immune reactivity. [20] Alternatively, this may simply represent a function of time, as the longer duration of microbial antigen exposure may increase eventual rate of conversion to another form of mucosal inflammation.…”

Section: Discussionmentioning

confidence: 99%

Antitumour necrosis factor therapy is associated with de novo Crohn’s disease after ileal pouch‐anal anastomosis

et al. 2021

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Aim Tumour necrosis factor inhibitors (TNFi) have revolutionized the management of moderate to severe ulcerative colitis (UC) since their approval for UC in 2005. However, many patients ultimately require surgery with ileal pouch‐anal anastomosis (IPAA). Development of de novo Crohn's disease (CD) following IPAA is an increasingly common and devastating complication, sometimes progressing to pouch failure. The aim of this study was to evaluate the association of preoperative TNFi exposure and the development of de novo CD after IPAA. Method A prospective single‐centre inflammatory bowel disease (IBD) registry was searched for consecutive patients with UC undergoing IPAA during a 25‐year period ending July 2018. Patients with preoperative CD or IBD‐unclassified were excluded. De novo CD was diagnosed upon endoscopic evidence of five or more mucosal ulcers proximal to the ileal pouch any time after surgery and/or pouch fistula occurring more than three months after ileostomy closure. Results The study cohort consisted of 400 patients with a median follow‐up of 44.0 (IQR 11–113) months. Sixty‐two (16%) patients developed de novo CD 28.0 (IQR 6–67) months following ileostomy closure. Survival analysis of TNFi era patients revealed a significant increase in de novo CD risk in those with preoperative TNFi exposure. Multivariable proportional hazards modelling revealed two independent predictors for de novo CD development: older age was protective (HR 0.89 per 5‐year increase; P = 0.009) and preoperative TNFi exposure was hazardous (HR 2.10; P = 0.011). Conclusion This prospective study is the first to suggest an association between preoperative TNFi exposure and the development of de novo CD.

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“…Restorative proctocolectomy with IPAA is the standard surgical treatment for UC (Buskens 2014;Koh 2016), and approximately 15% of patients with UC undergo a colectomy within 10 years of diagnosis (Frolkis 2013). IPAA involves the construction of an internal pouch utilizing a distal portion of the remaining small intestine to create a reservoir for stool (McGuire 2007).…”

Section: Description Of the Interventionmentioning

confidence: 99%

The impact of surgical therapies for inflammatory bowel disease on female fertility

Lee

Crowe

Seow

et al. 2019

Cochrane Database of Systematic Reviews

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Clinical Factors Associated with the Development of Crohnʼs Disease in Inflammatory Bowel Disease-unclassified Patients Undergoing Ileal Pouch–anal Anastomosis

Abstract: Younger age at disease onset is the only clinical factor associated with the development of CD after IPAA for IBDU. Patients with IBDU undergoing IPAA with young age at disease onset should be counseled about the potentially higher risk of developing CD.

Cited by 6 publications

References 24 publications

Clinical features of inflammatory bowel disease unclassified: a case-control study

Clinical features of inflammatory bowel disease unclassified: a case-control study

Antitumour necrosis factor therapy is associated with de novo Crohn’s disease after ileal pouch‐anal anastomosis

The impact of surgical therapies for inflammatory bowel disease on female fertility

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