Family History and Serology Predict Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Melmed, Gil Y.; Fleshner, Phillip; Bardakcioglu, Ovunc; Ippoliti, Andrew; Vasiliauskas, Eric A.; Papadakis, Konstantinos A.; Dubinsky, Marla; Landers, Carol J.; Rotter, Jerome I.; Targan, Stephan R.

doi:10.1007/s10350-007-9158-3

Cited by 110 publications

(80 citation statements)

References 48 publications

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“…Only rarely does refractory or recurrent pouchitis occur because of the missed diagnosis of CD ( 341 ), which may occur more commonly in patients with a family history of CD or preoperative antisaccharomyces cerevisiae antibody seropositivity ( 342 ). CD of the pouch should be suspected if a de novo fi stula develops 6 -12 months aft er ileostomy takedown in the absence of postoperative leak, abscess, or sepsis.…”

Section: Recommendations For the Management Of Pouchitismentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: Recommendations For the Management Of Pouchitismentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,154

977

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“…pANCA has been shown to be associated with less severe disease, UC-like disease and to be negatively associated with small bowel complication [36,39] . ASCA positivity has been associated with CD of the pouch after ileal pouch-anal anastomosis (IPAA) [40] .…”

Section: Serological Predictors Of CD Coursementioning

confidence: 99%

Clinical, serological and genetic predictors of inflammatory bowel disease course

Beaugerie¹

2012

WJG

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Patients with extensive or complicated Crohn's disease (CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines. In patients with localized and uncomplicated CD at diagnosis, early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact. In this context, there is a need for predictors of benign or unfavourable subsequent clinical course, in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions. At diagnosis, an age below 40 years, the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course. The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts. Consequently, the use of these predictors can be integrated into the elements that influence individual decisions. In the CD postoperative context, keeping smoking and history of prior resection are the strongest predictors of disease symptomatic recurrence. However, these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice. In ulcerative colitis (UC), extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease, and also with long-term colectomy and colorectal inflammation-associated colorectal cancer. In patients with extensive UC at diagnosis, a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered. At the moment, no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identified.

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“…In addition to a preoperative diagnosis of CD, 12 other reported risk factors for the development of CD of the pouch include sero-positive anti-Saccharomyces cerevisiae-IgA, 25 a family history of CD, 25,26 being active smoker, 27 a long duration of pouch, and a preoperative diagnosis of IC. 27,28 Different phenotypes of CD of the pouch were shown to be associated with different risk factors.…”

Section: Discussionmentioning

confidence: 99%

Natural history of Crohn’s disease in patients who underwent intentional restorative proctocolectomy with ileal pouch‐anal anastomosis

Shen

Patel

Lian

2010

Aliment Pharmacol Ther

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Family History and Serology Predict Crohn's Disease after Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Cited by 110 publications

References 48 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Clinical, serological and genetic predictors of inflammatory bowel disease course

Natural history of Crohn’s disease in patients who underwent intentional restorative proctocolectomy with ileal pouch‐anal anastomosis

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