Non-surgical porto-mesenteric vein thrombosis is associated with worse long-term outcomes in inflammatory bowel diseases

Abstract

Objective: Our aim was to assess the risk factors for non-surgery-related portal and mesenteric vein thrombosis (PMVT) and its impact on the outcomes of inflammatory bowel diseases (IBD).Methods: All patients with a concurrent diagnosis of IBD and PMVT between January 2004 and October 2013 were identified from the electronic medical record (study group; n = 20). Patients were matched for age, sex, and IBD phenotype with control IBD patients who had no PMVT, with a ratio of 1:3 (control group; n = 60). Risk factors for PMVT and IBD-related outcomes at one year after diagnosis of PMVT were compared between the two groups.Results: Of the 20 patients in the Study group, 6 (30%) had UC, 14 (70%) had CD and 11 (55%) were male. On multivariable analysis, inpatient status (odds ratio [OR] 6.88; 95% confidence interval [CI] 1.88–25.12) and baseline corticosteroid use (OR 4.39; 95% CI 1.27–15.19) were found to be independent risk factors for the development of PMVT. At one-year follow-up, PMVT patients were more likely to have an adverse outcome of IBD, including subsequent emergency room visit (26.3% vs. 1.7%; P = 0.003), hospitalization for medical management (60.0% vs. 20.0%; P = 0.001) or IBD-related surgery (65.0% vs. 26.7%; P = 0.003) than the non-PMVT controls. In multivariable analysis, PMVT (OR 5.19; 95% CI 1.07–25.28) and inpatient status (OR 8.92; 95% CI 1.33–59.84) were found to be independent risk factors for poor outcome, whereas baseline immunomodulator use (OR 0.07; 95% CI 0.01–0.51) was found to be a protective factor.Conclusions: IBD patients who were inpatients or receiving corticosteroid therapy had an increased risk of the development of PMVT. The presence of PMVT was associated with poor clinical outcomes in IBD.

Splanchnic Vein Thrombosis in Inflammatory Bowel Disease: An Observational Study from the ENEIDA Registry and Systematic Review

“…Multiple factors have been associated with an increased risk of thrombotic events in IBD, particularly inflammatory disease activity ( [7][8][9]). In our cohort, disease activity was measured objectively with clinical scores and, in line with previous studies, we found that SVT occurred in patients with active IBD in two-thirds of the cases [11,20]. Although individual data from the systematic review were available only qualitatively and in 173 patients, more than half of them also had active disease.…”

“…The oldest article was published in 1979 and the most recent one in 2022; 44 out of 60 were published after 2000. All of them were retrospective, two were multicentre studies [4,11], six were single-centre studies [19][20][21][22][23][24] and fifty-two were case reports or case series . Most of the articles reported between one and five cases of SVT, and only four studies reported more than thirty [4,11,19,24].…”

Recurrent Unprovoked Venous Thrombosis (Cerebral Sinus Thrombosis and Mesenteric Vein Thrombosis) in Young Patient with Crohn’s Disease: A Case Report and Review

“…Inflammatory bowel diseases (IBD) patients are at high risk of venous thromboembolism (VTE) as a result of the hypercoagulable state induced by chronic inflammation of the bowel [3]. Ongoing active inflammation in IBD itself appears to be a significant factor determining the VTE risk [4].…”

Nontransplant options for portomesenteric thrombosis

“…More recently, PMT has been gaining attention as a serious complication of bariatric surgery in the era of global obesity epidemic [5][6][7], which might result in small bowel or liver transplantation in the worstcase scenario [8,9]. PMT has also been reported in patients with inflammatory bowel disease, which the global incidence is also rising [10,11]. We will briefly review anticoagulation, thrombolysis, transjugular intrahepatic portosystemic shunt (TIPS), and MesoRex bypass for treating PMT both in cirrhotic and noncirrhotic patients.…”