Risk of Early Surgery for Crohn's Disease: Implications for Early Treatment Strategies

Sands, Bruce E.; Arsenault, Joanne; Rosen, Michael J.; Alsahli, Mazen; Bailen, Laurence; Banks, Peter A.; Bensen, Steven P.; Bousvaros, Athos; Cave, David R.; Cooley, J.; Cooper, Herbert L.; Edwards, Susan; Farrell, Richard J.; Griffin, Michael; Hay, David W.; John, Alex; Lidofsky, Sheldon; Olans, Lori; Peppercorn, Mark A.; Rothstein, Richard I.; Roy, Michael A.; Saletta, Michael J; Shah, Samir A.; Warner, Andrew S.; Wolf, Jacqueline L.; Vecchio, James; Winter, Harland S.; Zawacki, John K.

doi:10.1111/j.1572-0241.2003.08674.x

Cited by 127 publications

(36 citation statements)

References 15 publications

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“…The literature, however, is limited as it deals chiefly with the impact of tobacco in patients with CD undergoing resection [14][15][16][17]. While previous research on patients with CD has emphasized the influence of tobacco exposure on the course of the disease [1,6,[8][9][10][11][18][19][20][21], there has been a limited focus on the effect that smoking may or may not have on the surgical outcome. The present work demonstrates that current smokers experienced increased 30-day postoperative complications (primarily related to infectious and pulmonary-related postoperative complications) and readmission compared with non-or ex-smokers.…”

Section: Discussionmentioning

confidence: 99%

Impact of smoking on the surgical outcome of Crohn's disease: a propensity‐score matched National Surgical Quality Improvement Program analysis

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Impact of smoking on the surgical outcome of Crohn's disease: a propensity‐score matched National Surgical Quality Improvement Program analysis

et al. 2015

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“…Consequently, the operative rate is estimated to be 80% at 20 years after onset of the disease [1,2,3]. After surgery, 40% of patients are symptomatic within 4 years [4], and many patients (≈30%) experience disease recurrence and require a second operation within 10 years [5].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Maintained Mucosal Healing in Patients with Crohn's Disease under Treatment with Infliximab Using Diffusion-Weighted Magnetic Resonance Imaging

Sakuraba¹,

Ishiguro²,

Hasui³

et al. 2014

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Background: Maintenance of mucosal healing may lead to a better outcome in patients with Crohn's disease (CD). Magnetic resonance diffusion-weighted imaging (MR-DWI) scans 1 year after infliximab (IFX) induction therapy were assessed as predictors of maintained response, or remission, through 3 years of treatment in patients with CD. Summary: MR-DWI and endoscopy data were prospectively collected throughout IFX treatment. Altogether, 86 lesions from 13 patients given IFX as induction (weeks 0, 2 and 6) and maintenance (5 mg/kg every 8 weeks beginning at week 14) therapy were analyzed with MR-DWI for 0.5-1.5 years from the starting point. Mucosal findings were confirmed by endoscopy at 1 and 3 years (gold standard). Of the 86 lesions, 65 were graded ‘0' and 21 were graded ‘1' based on their hyperintensity (HI; or lack thereof) on MR-DWI. Two years after the first evaluation, 7 of 15 false-negative lesions had turned positive based on colonoscopy findings, and 60 of 62 true-negative lesions had not. Thus, 0.03% of those predicted to remain in remission had relapsed (negative predictive value 0.9677, p < 0.0001). MR-DWI-HI at 1 year coincided with the presence of endoscopic inflammation, with sensitivity of 66.67%, specificity of 80.52%, and an area under the curve (AUC) value of 0.7359 (0.5479-0.9240, p = 0.0211). The AUC value of MR-DWI-HI at 3 years was 0.8402 (0.7460-0.9343, p = 0.001) with sensitivity of 94.12% and specificity of 73.91%. Key Message: A definition of the response on the basis of MR-DWI-HI might be helpful for optimizing treatment for patients with CD under treatment with IFX.

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“…The cumulative risk of surgery after diagnosis has been estimated to be around 80% [10,12,13,21,22] and the very recent observations from the population-based Olmsted County also confirm surgery rates found after 20 years of disease duration in our study [23]. When comparing the characteristics of the population of postoperative patients, we observed that mean age at first intestinal resection was nearly 10 years higher compared to other cohorts [24], which may indicate either that a significant effort has been made and achieved to delay the time to first RS, or that the disease remained undetected for a longer period before diagnosis [25], which might be the case for ileal diseases [26].…”

Section: Discussionmentioning

confidence: 99%

Penetrating or Stricturing Diseases are the Major Determinants of Time to First and Repeat Resection Surgery in Crohn's Disease

et al. 2013

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Background: About 80% of patients with Crohn's disease (CD) require bowel resection and up to 65% will undergo a second resection within 10 years. This study reports clinical risk factors for resection surgery (RS) and repeat RS. Methods: Retrospective cohort study, using data from patients included in the Swiss Inflammatory Bowel Disease Cohort. Cox regression analyses were performed to estimate rates of initial and repeated RS. Results: Out of 1,138 CD cohort patients, 417 (36.6%) had already undergone RS at the time of inclusion. Kaplan-Meier curves showed that the probability of being free of RS was 65% after 10 years, 42% after 20 years, and 23% after 40 years. Perianal involvement (PA) did not modify this probability to a significant extent. The main adjusted risk factors for RS were smoking at diagnosis (hazard ratio (HR) = 1.33; p = 0.006), stricturing with vs. without PA (HR = 4.91 vs. 4.11; p < 0.001) or penetrating disease with vs. without PA (HR = 3.53 vs. 4.58; p < 0.001). The risk factor for repeat RS was penetrating disease with vs. without PA (HR = 3.17 vs. 2.24; p < 0.05). Conclusion: The risk of RS was confirmed to be very high for CD in our cohort. Smoking status at diagnosis, but mostly penetrating and stricturing diseases increase the risk of RS.

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Risk of Early Surgery for Crohn's Disease: Implications for Early Treatment Strategies

Abstract: The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that improved risk stratification and potent therapies with rapid onset of action are needed to modify the natural history of Crohn's disease.

Cited by 127 publications

References 15 publications

Impact of smoking on the surgical outcome of Crohn's disease: a propensity‐score matched National Surgical Quality Improvement Program analysis

Impact of smoking on the surgical outcome of Crohn's disease: a propensity‐score matched National Surgical Quality Improvement Program analysis

Prediction of Maintained Mucosal Healing in Patients with Crohn's Disease under Treatment with Infliximab Using Diffusion-Weighted Magnetic Resonance Imaging

Penetrating or Stricturing Diseases are the Major Determinants of Time to First and Repeat Resection Surgery in Crohn's Disease

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