Prospective Study of Long-Term Results and Prognostic Factors After Conservative Surgery for Small Bowel Crohn's Disease

Sampietro, Gianluca; Corsi, Fabio; Maconi, Giovanni; Ardizzone, Sandro; Frontali, Alice; Corona, Alberto; Porro, G. Bianchi; Foschi, Diego

doi:10.1016/j.cgh.2008.10.008

Cited by 52 publications

(39 citation statements)

References 83 publications

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“…8,9 Also, though less common, SBS can occur in adults because of multiple resections in the setting of Crohn's disease, or with mesenteric ischemia secondary to vascular disease. 10,11 Because SBS patients cannot maintain sufficient nutrition with enteral intake, they may require long-term total parenteral nutrition, which itself can be complicated in children by liver failure and cirrhosis. 12 SBS patients therefore endure significant healthcare costs, recently estimated to be on the order of $1.6 million per patient over 5 years.…”

Section: Discussionmentioning

confidence: 99%

Tissue Engineering of the Intestine in a Murine Model

Barthel

Speer

Levin

et al. 2012

JoVE

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Tissue-engineered small intestine (TESI) has successfully been used to rescue Lewis rats after massive small bowel resection, resulting in return to preoperative weights within 40 days.1 In humans, massive small bowel resection can result in short bowel syndrome, a functional malabsorptive state that confers significant morbidity, mortality, and healthcare costs including parenteral nutrition dependence, liver failure and cirrhosis, and the need for multivisceral organ transplantation. 2 In this paper, we describe and document our protocol for creating tissueengineered intestine in a mouse model with a multicellular organoid units-on-scaffold approach. Organoid units are multicellular aggregates derived from the intestine that contain both mucosal and mesenchymal elements, 3 the relationship between which preserves the intestinal stem cell niche. 4 In ongoing and future research, the transition of our technique into the mouse will allow for investigation of the processes involved during TESI formation by utilizing the transgenic tools available in this species. 5The availability of immunocompromised mouse strains will also permit us to apply the technique to human intestinal tissue and optimize the formation of human TESI as a mouse xenograft before its transition into humans. Our method employs good manufacturing practice (GMP) reagents and materials that have already been approved for use in human patients, and therefore offers a significant advantage over approaches that rely upon decellularized animal tissues. The ultimate goal of this method is its translation to humans as a regenerative medicine therapeutic strategy for short bowel syndrome. Video LinkThe video component of this article can be found at

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Section: Discussionmentioning

confidence: 99%

Tissue Engineering of the Intestine in a Murine Model

Barthel

Speer

Levin

et al. 2012

JoVE

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“…De plus, l'absence de traitement médical prophylactique est associée à un risque élevé de récidive [19][20][21].…”

Section: Discussionunclassified

Facteurs prédictifs de la récidive postopératoire après résection iléocæcale pour maladie de Crohn

Said

Dabbabi

Bettaieb

et al. 2011

J Afr Hepato Gastroenterol

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Introduction : Malgré l'efficacité prouvée de plusieurs agents biologiques dans l'induction et le maintien de la rémission au cours de la maladie de Crohn (MC), près de 80 % des patients nécessitent le recours à une résection intestinale durant leur vie. Cette chirurgie n'est pas définitive-ment curative, puisque la récidive postopératoire (RPO) est fréquente et pose des problèmes de prise en charge. But : Évaluer les facteurs prédictifs de la RPO après résec-tion iléocaecale (RIC) pour MC. Patients et méthodes : Étude rétrospective incluant tous les patients atteints de MC et ayant subi une RIC entre 2000 et 2009. La récidive de la maladie était définie par la présence de signes endoscopiques d'activité en l'absence ou en présence de symptômes. Afin de déterminer les facteurs de risque de la RPO au cours de la MC, nous avons procédé à une analyse univariée des différentes variables rapportées dans la littéra-ture comme influençant l'évolution postopératoire, suivie d'une analyse multivariée par régression logistique. Résultats : Cinquante-deux patients ont été colligés. Une RPO était notée chez 15 patients (28,8 %), après un suivi moyen de 31,9 mois [1-126]. En analyse univariée, quatre facteurs étaient associés à un risque élevé de RPO : les anté-cédents (ATCD) familiaux de maladies inflammatoires chroniques de l'intestin (p = 0,007), la RIC dans la première année après le diagnostic de la MC (p = 0,004), la longueur du grêle réséqué (p = 0,025) et la présence de granulome sur la pièce opératoire (p = 0,035). En analyse multivariée, seule la chirurgie dans la première année après le diagnostic était retenue comme facteur indépendant de récidive après RIC pour MC. Conclusion : Après RIC pour MC, la récidive est relativement fréquente et intéresse particulièrement les patients opé-rés dans la première année suivant le diagnostic. Pour citer cette revue : J. Afr. Hépatol. Gastroentérol. 5 (2011).

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“…Treatment should be started with the goal to heal lesions for preventing symptoms. Mucosal healing is probably not a sufficient objective and healing of the whole width of the intestinal wall should be achieved, as it has been shown that thickening of the neoterminal ileum is associated with subsequent development of surgical recurrence [39] . Thus one can imagine to check regularly a patient for the presence of intestinal ulcerations and thickening, using non-invasive techniques (CRP, ferritin, fecal calprotectin, videocapsule and MRI) and to treat as early as possible an asymptomatic patient in order to prevent the development of symptoms and complications.…”

Section: Treat Lesions Not Symptomsmentioning

confidence: 99%

Can We Modulate the Clinical Course of Inflammatory Bowel Diseases by Our Current Treatment Strategies?

Cosnes¹

2009

Dig Dis

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Ulcerative colitis and Crohn’s disease are chronic disabling lifelong diseases which may be disturbed by severe flares and anatomical complications requiring surgery. Until the very last years there was no clear indication that treatment was able to modify the long-term natural history of the disease. In particular, there are no data demonstrating a clear improvement through the period 1950–2003 in disease activity, occurrence of complications and need for surgery, in spite of an increased use of immunosuppressants since the 1990s. However, in inflammatory bowel disease, both thiopurines and methotrexate are very efficient in about one half of the patients, and in responders, may heal the mucosa and decrease the need for surgery. The early use of immunosuppressants in selected patients may have an impact on occurrence of severe flares and complications, and need for surgery. Moreover, anti-TNF now used for 10 years in Crohn’s disease and for 5 years in ulcerative colitis demonstrated in two thirds of the patients a remarkable anatomic effect, healing the mucosa, closing fistulae and preventing strictures. Infliximab does prevent endoscopic recurrence following ileal resection for Crohn’s disease. Actually, because irreversible anatomical damage may develop during the first years of disease, there is a need to classify early in the course of the disease patients who will benefit from anti-TNF and classical immunosuppressants, respectively. There is the need in the next few years to better define these subgroups and to compare different strategies within each group through randomized interventional studies.

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Prospective Study of Long-Term Results and Prognostic Factors After Conservative Surgery for Small Bowel Crohn's Disease

Cited by 52 publications

References 83 publications

Tissue Engineering of the Intestine in a Murine Model

Tissue Engineering of the Intestine in a Murine Model

Facteurs prédictifs de la récidive postopératoire après résection iléocæcale pour maladie de Crohn

Can We Modulate the Clinical Course of Inflammatory Bowel Diseases by Our Current Treatment Strategies?

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