Abstract:Surgical management of complicated IBD during pregnancy and the puerperium needs to be tailored to disease severity, the type of complications and foetal status. It should involve gastroenterologists, colorectal surgeons, obstetricians and neonatal specialists in a multidisciplinary manner within a single unit.
“…The CD patients, with clinical diagnoses according to the local endoscopy, pathology, and pharmacy records, [8] came from the Gastroenterology and Emergency departments of Nanfang Hospital, Southern Medical University, as well as the Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, between October 2013 to December 2016. CD patients with tumors, tuberculosis, autoimmune diseases, pregnancy, [9] or poor compliance were excluded. [10] Overall, 65 CD subjects were enrolled in this study, ranging in age from 12 to 61 years.…”
Crohn disease (CD) with complications such as penetrating, stricturing, and perianal disease is called complicated CD. The aim of this study is to test the efficiency with which the CD8+CD28+/CD8+CD28– cell balance can predict a subsequent active stage in patients with newly diagnosed complicated CD.Seventeen patients with complicated CD and 48 CD patients with no complications were enrolled. Blood CD8+ T cells were tested from all of the 65 newly diagnosed CD patients upon enrollment. The potential risk factors were compared between the 2 groups. A 30-week follow-up was performed, and the efficiency of the CD8+ cell balance at predicting active CD was analyzed using receiver-operating characteristic curves. The cumulative remission lasting rates (CRLRs) were analyzed using the Kaplan–Meier method.Compared with the control CD group, patients with complicated CD were predominantly male and younger in age; they also had lower body mass indices (BMIs), higher Crohn disease activity indices (CDAIs), higher immunosuppressant and steroid prescription rates, and significantly higher surgical rates. The CD8+CD28+/CD8+CD28– balance was associated with BMI, CDAI, steroids, and surgery. The CD8+CD28+/CD8+CD28– ratios were significantly lower at week 0 and on the 6th, 22nd, and 30th week during follow-up with a shorter lasting time of remission for the complicated CD patients. The CD8+CD28+/CD8+CD28– ratio could accurately predict the active stage for the patients with complicated CD, and the highest sensitivity (89.2%) and specificity (85.3%) were found when the ratio was 1.03. Treatment with steroids and surgery, along with a significantly lower CD8+CD28+/CD8+CD28– ratio and lower CRLRs, was closely related to a worse outcome for the patients with complicated CD.Patients requiring steroids and surgery experience more severe disease activity and thus a disequilibrated immunological balance, which could be the main reason for a decreased CD8+CD28+/CD8+CD28– ratio. This ratio can sensitively predict the active stage for patients with complicated CD, and more care should be taken when this ratio is <1.03.
“…The CD patients, with clinical diagnoses according to the local endoscopy, pathology, and pharmacy records, [8] came from the Gastroenterology and Emergency departments of Nanfang Hospital, Southern Medical University, as well as the Department of Gastroenterology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, between October 2013 to December 2016. CD patients with tumors, tuberculosis, autoimmune diseases, pregnancy, [9] or poor compliance were excluded. [10] Overall, 65 CD subjects were enrolled in this study, ranging in age from 12 to 61 years.…”
Crohn disease (CD) with complications such as penetrating, stricturing, and perianal disease is called complicated CD. The aim of this study is to test the efficiency with which the CD8+CD28+/CD8+CD28– cell balance can predict a subsequent active stage in patients with newly diagnosed complicated CD.Seventeen patients with complicated CD and 48 CD patients with no complications were enrolled. Blood CD8+ T cells were tested from all of the 65 newly diagnosed CD patients upon enrollment. The potential risk factors were compared between the 2 groups. A 30-week follow-up was performed, and the efficiency of the CD8+ cell balance at predicting active CD was analyzed using receiver-operating characteristic curves. The cumulative remission lasting rates (CRLRs) were analyzed using the Kaplan–Meier method.Compared with the control CD group, patients with complicated CD were predominantly male and younger in age; they also had lower body mass indices (BMIs), higher Crohn disease activity indices (CDAIs), higher immunosuppressant and steroid prescription rates, and significantly higher surgical rates. The CD8+CD28+/CD8+CD28– balance was associated with BMI, CDAI, steroids, and surgery. The CD8+CD28+/CD8+CD28– ratios were significantly lower at week 0 and on the 6th, 22nd, and 30th week during follow-up with a shorter lasting time of remission for the complicated CD patients. The CD8+CD28+/CD8+CD28– ratio could accurately predict the active stage for the patients with complicated CD, and the highest sensitivity (89.2%) and specificity (85.3%) were found when the ratio was 1.03. Treatment with steroids and surgery, along with a significantly lower CD8+CD28+/CD8+CD28– ratio and lower CRLRs, was closely related to a worse outcome for the patients with complicated CD.Patients requiring steroids and surgery experience more severe disease activity and thus a disequilibrated immunological balance, which could be the main reason for a decreased CD8+CD28+/CD8+CD28– ratio. This ratio can sensitively predict the active stage for patients with complicated CD, and more care should be taken when this ratio is <1.03.
“…Management is complicated by the presence of two patients, the woman and her unborn fetus. The management strategy adopted will be uniquely case specific and requires a multidisciplinary approach with obstetricians, neonatologists, obstetric anaesthetists, gastroenterologists and colorectal surgeons .…”
Section: Surgery For Ibd In Pregnancymentioning
confidence: 99%
“…The literature reflecting current practice suggests the risk of surgery to the woman is similar to that in her nonpregnant state. Abdominal surgery for IBD in the third trimester is associated with almost universal precipitation of preterm labour . Surgery in the first trimester is associated with higher rates of miscarriage prompting some to suggest a preference for the second trimester, but no trimester is immune from these complications .…”
Section: Surgery For Ibd In Pregnancymentioning
confidence: 99%
“…Over recent years there has been significant growth in the use of interventional radiological techniques in general with up‐skilling of interventional radiological teams. These techniques may allow deferral of surgery until a more favourable time in a pregnancy . A futile radiological intervention can also introduce harmful delay and the clinician must set clear achievable objectives with regular clinical review.…”
Section: Surgery For Ibd In Pregnancymentioning
confidence: 99%
“…Management is complicated by the presence of two patients, the woman and her unborn fetus. The management strategy adopted will be uniquely case specific and requires a multidisciplinary approach with obstetricians, neonatologists, obstetric anaesthetists, gastroenterologists and colorectal surgeons [775][776][777]. Parameters such as temperature, stool frequency and CRP levels are unaffected and may take more prominence in assessment [761,778].…”
Aim
There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
Methods
Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
Results
All aspects of surgical care for IBD have been included along with 157 recommendations for management.
Conclusion
These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
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