Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 4/2016

01.08.2016 | original article

Clinical and inflammatory response to first ileocolic resection for Crohn’s disease

An analysis of 117 cases

verfasst von: M.D. Hanna Ribbing Wilén, M.D., Ph.D. Per-Olof Nyström, M.D., Ph.D. Leif Törkvist, M.D., Ph.D. Johannes Blom

Erschienen in: European Surgery | Ausgabe 4/2016

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

The intention of the first ileocolic resection in Crohn’s disease is to remove local disease, which relieves symptoms of intestinal obstruction, but should also relieve clinically significant systemic inflammation and allow discontinuation of corticosteroids.

Methods

By means of five clinically relevant criteria for continued specific treatment, we evaluated the response of 117 patients to their first ileocolic resection for Crohn’s disease, which was undertaken at Karolinska University Hospital, Stockholm, Sweden, between 2000 and 2010. The five criteria were the persistence of systemic inflammation and continued or resumed corticosteroid therapy, high defecation frequency or presence of a stoma, and the need for new bowel surgery within 1 year. The presence of systemic inflammation and use of anti-inflammatory drugs were assessed 1 month preoperatively and 6–12 months after surgery. Other events of interest were assessed within 12 months.

Results

The median age was 31 years and 51 patients (44 %) were women. In all, 54 patients (46 %) were operated on within the first year of diagnosis and episodes of bowel obstruction were the prime surgical indication in 80 (68 %) patients. Of the patients, 100 (85 %) had an ileocolic resection and 17 (15 %) had terminal ileal surgery. As anticipated, C‑reactive protein (CRP), albumin, and hemoglobin concentrations all normalized significantly after surgery but 15 (13 %) patients still had CRP values of ≥ 30 mg/l and one fourth (29/117, 25 %) still used corticosteroids. Seventeen patients (15 %) had six or more defecations per day or a temporary stoma and four (3 %) patients had new surgery for symptomatic Crohn’s disease. Altogether, 46 (39 %) patients met one or more of the criteria for continued or renewed treatment within 1 year with a higher risk in patients with ileocolic disease as compared with ileal disease when adjusted for age and reoperation (p = 0.030).

Conclusion

The curable intention of the first ileocolic resection for Crohn’s disease often fails, as the need for continued or renewed medical or surgical treatment in the first year is high.
Literatur
1.
2.
Zurück zum Zitat Sjoberg D, Holmstrom T, Larsson M, Nielsen AL, Holmquist L, Ekbom A, Ronnblom A. Incidence and clinical course of crohn’s disease during the first year – results from the ibd cohort of the uppsala region (icure) of sweden 2005–2009. J Crohns Colitis. 2014;8:215–22. CrossRefPubMed Sjoberg D, Holmstrom T, Larsson M, Nielsen AL, Holmquist L, Ekbom A, Ronnblom A. Incidence and clinical course of crohn’s disease during the first year – results from the ibd cohort of the uppsala region (icure) of sweden 2005–2009. J Crohns Colitis. 2014;8:215–22. CrossRefPubMed
3.
Zurück zum Zitat Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal crohn’s disease. Br J Surg. 2000;87:1697–701. CrossRefPubMed Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal crohn’s disease. Br J Surg. 2000;87:1697–701. CrossRefPubMed
4.
Zurück zum Zitat Henriksen M, Jahnsen J, Lygren I, Stray N, Sauar J, Vatn MH, Moum B, Group IS. C‑reactive protein: A predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008;57:1518–23. CrossRefPubMed Henriksen M, Jahnsen J, Lygren I, Stray N, Sauar J, Vatn MH, Moum B, Group IS. C‑reactive protein: A predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008;57:1518–23. CrossRefPubMed
5.
Zurück zum Zitat Reimund JM, Arondel Y, Escalin G, Finck G, Baumann R, Duclos B. Immune activation and nutritional status in adult crohn’s disease patients. Dig Liver Dis. 2005;37:424–31. CrossRefPubMed Reimund JM, Arondel Y, Escalin G, Finck G, Baumann R, Duclos B. Immune activation and nutritional status in adult crohn’s disease patients. Dig Liver Dis. 2005;37:424–31. CrossRefPubMed
6.
Zurück zum Zitat Bager P, Befrits R, Wikman O, Lindgren S, Moum B, Hjortswang H, Dahlerup JF. The prevalence of anemia and iron deficiency in ibd outpatients in scandinavia. Scand J Gastroenterol. 2011;46:304–9. CrossRefPubMed Bager P, Befrits R, Wikman O, Lindgren S, Moum B, Hjortswang H, Dahlerup JF. The prevalence of anemia and iron deficiency in ibd outpatients in scandinavia. Scand J Gastroenterol. 2011;46:304–9. CrossRefPubMed
7.
Zurück zum Zitat Burisch J, Pedersen N, Cukovic-Cavka S, Turk N, Kaimakliotis I, Duricova D, Shonova O, Vind I, Avnstrom S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Bailey Y, O’Morain C, Schwartz D, Odes S, Martinato M, Lombardini S, Jonaitis L, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Fernandez A, Hernandez V, Almer S, Zhulina Y, Halfvarson J, Tsai HH, Sebastian S, Lakatos PL, Langholz E, Munkholm P, EpiCom G. Initial disease course and treatment in an inflammatory bowel disease inception cohort in europe: The ecco-epicom cohort. Inflamm Bowel Dis. 2014;20:36–46. CrossRefPubMed Burisch J, Pedersen N, Cukovic-Cavka S, Turk N, Kaimakliotis I, Duricova D, Shonova O, Vind I, Avnstrom S, Thorsgaard N, Krabbe S, Andersen V, Dahlerup JF, Kjeldsen J, Salupere R, Olsen J, Nielsen KR, Manninen P, Collin P, Katsanos KH, Tsianos EV, Ladefoged K, Lakatos L, Bailey Y, O’Morain C, Schwartz D, Odes S, Martinato M, Lombardini S, Jonaitis L, Kupcinskas L, Turcan S, Barros L, Magro F, Lazar D, Goldis A, Nikulina I, Belousova E, Fernandez A, Hernandez V, Almer S, Zhulina Y, Halfvarson J, Tsai HH, Sebastian S, Lakatos PL, Langholz E, Munkholm P, EpiCom G. Initial disease course and treatment in an inflammatory bowel disease inception cohort in europe: The ecco-epicom cohort. Inflamm Bowel Dis. 2014;20:36–46. CrossRefPubMed
8.
Zurück zum Zitat D’Haens G, Baert F, Assche G van, Caenepeel P, Vergauwe P, Tuynman H, De Vos M, Deventer S van, Stitt L, Donner A, Vermeire S, Van de Mierop FJ, Coche JC, Woude J van der, Ochsenkuhn T, Bodegraven AA van, Van Hootegem PP, Lambrecht GL, Mana F, Rutgeerts P, Feagan BG, Hommes D, Belgian Inflammatory Bowel Disease Research G, North-Holland Gut C. Early combined immunosuppression or conventional management in patients with newly diagnosed crohn’s disease: An open randomised trial. Lancet. 2008;371:660–7. CrossRefPubMed D’Haens G, Baert F, Assche G van, Caenepeel P, Vergauwe P, Tuynman H, De Vos M, Deventer S van, Stitt L, Donner A, Vermeire S, Van de Mierop FJ, Coche JC, Woude J van der, Ochsenkuhn T, Bodegraven AA van, Van Hootegem PP, Lambrecht GL, Mana F, Rutgeerts P, Feagan BG, Hommes D, Belgian Inflammatory Bowel Disease Research G, North-Holland Gut C. Early combined immunosuppression or conventional management in patients with newly diagnosed crohn’s disease: An open randomised trial. Lancet. 2008;371:660–7. CrossRefPubMed
9.
Zurück zum Zitat Sakatani A, Fujiya M, Ito T, Inaba Y, Ueno N, Kashima S, Tominaga M, Moriichi K, Okamoto K, Tanabe H, Ikuta K, Ohtake T, Kono T, Furukawa H, Ashida T, Kohgo Y. Infliximab extends the duration until the first surgery in patients with crohn’s disease. Biomed Res Int. 2013;2013:879491. CrossRefPubMedPubMedCentral Sakatani A, Fujiya M, Ito T, Inaba Y, Ueno N, Kashima S, Tominaga M, Moriichi K, Okamoto K, Tanabe H, Ikuta K, Ohtake T, Kono T, Furukawa H, Ashida T, Kohgo Y. Infliximab extends the duration until the first surgery in patients with crohn’s disease. Biomed Res Int. 2013;2013:879491. CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, Harrison J, Plevy SE. Infliximab prevents crohn’s disease recurrence after ileal resection. Gastroenterology. 2009;136:441–50. CrossRefPubMed Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, Harrison J, Plevy SE. Infliximab prevents crohn’s disease recurrence after ileal resection. Gastroenterology. 2009;136:441–50. CrossRefPubMed
11.
Zurück zum Zitat Riss S, Schuster I, Papay P, Mittlbock M, Stift A. Repeat intestinal resections increase the risk of recurrence of crohn’s disease. Dis Colon Rectum. 2013;56:881–7. CrossRefPubMed Riss S, Schuster I, Papay P, Mittlbock M, Stift A. Repeat intestinal resections increase the risk of recurrence of crohn’s disease. Dis Colon Rectum. 2013;56:881–7. CrossRefPubMed
12.
Zurück zum Zitat Riss S, Schuster I, Papay P, Herbst F, Mittlbock M, Chitsabesan P, Stift A. Surgical recurrence after primary ileocolic resection for crohn’s disease. Tech Coloproctol. 2014;18:365–71. CrossRefPubMed Riss S, Schuster I, Papay P, Herbst F, Mittlbock M, Chitsabesan P, Stift A. Surgical recurrence after primary ileocolic resection for crohn’s disease. Tech Coloproctol. 2014;18:365–71. CrossRefPubMed
13.
Zurück zum Zitat Walters TD, Steinhart AH, Bernstein CN, Tremaine W, McKenzie M, Wolff BG, McLeod RS. Validating crohn’s disease activity indices for use in assessing postoperative recurrence. Inflamm Bowel Dis. 2011;17:1547–56. CrossRefPubMed Walters TD, Steinhart AH, Bernstein CN, Tremaine W, McKenzie M, Wolff BG, McLeod RS. Validating crohn’s disease activity indices for use in assessing postoperative recurrence. Inflamm Bowel Dis. 2011;17:1547–56. CrossRefPubMed
14.
Zurück zum Zitat Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The montreal classification of inflammatory bowel disease: Controversies, consensus, and implications. Gut. 2006;55:749–53. CrossRefPubMedPubMedCentral Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The montreal classification of inflammatory bowel disease: Controversies, consensus, and implications. Gut. 2006;55:749–53. CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Clavien PA, Barkun J, Oliveira ML de, Vauthey JN, Dindo D, Schulick RD, Santibanes E de, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250:187–96. CrossRefPubMed Clavien PA, Barkun J, Oliveira ML de, Vauthey JN, Dindo D, Schulick RD, Santibanes E de, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250:187–96. CrossRefPubMed
16.
Zurück zum Zitat Waugh N, Cummins E, Royle P, Kandala NB, Shyangdan D, Arasaradnam R, Clar C, Johnston R. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: Systematic review and economic evaluation. Health Technol Assess. 2013;17(xv–xix):1–211. PubMedPubMedCentral Waugh N, Cummins E, Royle P, Kandala NB, Shyangdan D, Arasaradnam R, Clar C, Johnston R. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: Systematic review and economic evaluation. Health Technol Assess. 2013;17(xv–xix):1–211. PubMedPubMedCentral
17.
Zurück zum Zitat Bellinger J, Munoz-Bongrand N, Pariente B, Baudry C, Chirica M, Gornet JM, Allez M, Cattan P. Endoscopic and clinical recurrences after laparoscopic or open ileocolic resection in crohn’s disease. J Laparoendosc Adv Surg Tech A. 2014;24:617–22. CrossRefPubMed Bellinger J, Munoz-Bongrand N, Pariente B, Baudry C, Chirica M, Gornet JM, Allez M, Cattan P. Endoscopic and clinical recurrences after laparoscopic or open ileocolic resection in crohn’s disease. J Laparoendosc Adv Surg Tech A. 2014;24:617–22. CrossRefPubMed
18.
Zurück zum Zitat Yoshida EM. The crohn’s disease activity index, its derivatives and the inflammatory bowel disease questionnaire: A review of instruments to assess crohn’s disease. Can J Gastroenterol. 1999;13:65–73. CrossRefPubMed Yoshida EM. The crohn’s disease activity index, its derivatives and the inflammatory bowel disease questionnaire: A review of instruments to assess crohn’s disease. Can J Gastroenterol. 1999;13:65–73. CrossRefPubMed
19.
Zurück zum Zitat Welsch T, Hinz U, Loffler T, Muth G, Herfarth C, Schmidt J, Kienle P. Early re-laparotomy for post-operative complications is a significant risk factor for recurrence after ileocaecal resection for crohn’s disease. Int J Colorectal Dis. 2007;22:1043–9. CrossRefPubMed Welsch T, Hinz U, Loffler T, Muth G, Herfarth C, Schmidt J, Kienle P. Early re-laparotomy for post-operative complications is a significant risk factor for recurrence after ileocaecal resection for crohn’s disease. Int J Colorectal Dis. 2007;22:1043–9. CrossRefPubMed
20.
Zurück zum Zitat Wolters FL, Russel MG, Sijbrandij J, Ambergen T, Odes S, Riis L, Langholz E, Politi P, Qasim A, Koutroubakis I, Tsianos E, Vermeire S, Freitas J, Zeijl G van, Hoie O, Bernklev T, Beltrami M, Rodriguez D, Stockbrugger RW, Moum B. Phenotype at diagnosis predicts recurrence rates in crohn’s disease. Gut. 2006;55:1124–30. CrossRefPubMedPubMedCentral Wolters FL, Russel MG, Sijbrandij J, Ambergen T, Odes S, Riis L, Langholz E, Politi P, Qasim A, Koutroubakis I, Tsianos E, Vermeire S, Freitas J, Zeijl G van, Hoie O, Bernklev T, Beltrami M, Rodriguez D, Stockbrugger RW, Moum B. Phenotype at diagnosis predicts recurrence rates in crohn’s disease. Gut. 2006;55:1124–30. CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Vester-Andersen MK, Prosberg MV, Jess T, Andersson M, Bengtsson BG, Blixt T, Munkholm P, Bendtsen F, Vind I. Disease course and surgery rates in inflammatory bowel disease: A population-based, 7‑year follow-up study in the era of immunomodulating therapy. Am J Gastroenterol. 2014;109:705–14. CrossRefPubMed Vester-Andersen MK, Prosberg MV, Jess T, Andersson M, Bengtsson BG, Blixt T, Munkholm P, Bendtsen F, Vind I. Disease course and surgery rates in inflammatory bowel disease: A population-based, 7‑year follow-up study in the era of immunomodulating therapy. Am J Gastroenterol. 2014;109:705–14. CrossRefPubMed
22.
Zurück zum Zitat Henriksen M, Jahnsen J, Lygren I, Aadland E, Schulz T, Vatn MH, Moum B, Ibsen Study G. Clinical course in crohn’s disease: Results of a five-year population-based follow-up study (the ibsen study). Scand J Gastroenterol. 2007;42:602–10. CrossRefPubMed Henriksen M, Jahnsen J, Lygren I, Aadland E, Schulz T, Vatn MH, Moum B, Ibsen Study G. Clinical course in crohn’s disease: Results of a five-year population-based follow-up study (the ibsen study). Scand J Gastroenterol. 2007;42:602–10. CrossRefPubMed
23.
Zurück zum Zitat Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S, Gastroenterology IBDSotBSo. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571–607. CrossRefPubMed Mowat C, Cole A, Windsor A, Ahmad T, Arnott I, Driscoll R, Mitton S, Orchard T, Rutter M, Younge L, Lees C, Ho GT, Satsangi J, Bloom S, Gastroenterology IBDSotBSo. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011;60:571–607. CrossRefPubMed
24.
25.
Zurück zum Zitat Ford AC, Khan KJ, Talley NJ, Moayyedi P. 5‑aminosalicylates prevent relapse of crohn’s disease after surgically induced remission: Systematic review and meta-analysis. Am J Gastroenterol. 2011;106:413–20. CrossRefPubMed Ford AC, Khan KJ, Talley NJ, Moayyedi P. 5‑aminosalicylates prevent relapse of crohn’s disease after surgically induced remission: Systematic review and meta-analysis. Am J Gastroenterol. 2011;106:413–20. CrossRefPubMed
26.
Zurück zum Zitat Schwartz M, Regueiro M. Prevention and treatment of postoperative crohn’s disease recurrence: An update for a new decade. Curr Gastroenterol Rep. 2011;13:95–100. CrossRefPubMed Schwartz M, Regueiro M. Prevention and treatment of postoperative crohn’s disease recurrence: An update for a new decade. Curr Gastroenterol Rep. 2011;13:95–100. CrossRefPubMed
27.
Zurück zum Zitat Moran GW, Dubeau MF, Kaplan GG, Yang H, Seow CH, Fedorak RN, Dieleman LA, Barkema HW, Ghosh S, Panaccione R, Alberta Inflammatory Bowel Disease C. Phenotypic features of crohn’s disease associated with failure of medical treatment. Clin Gastroenterol Hepatol. 2014;12(434–42):e431. Moran GW, Dubeau MF, Kaplan GG, Yang H, Seow CH, Fedorak RN, Dieleman LA, Barkema HW, Ghosh S, Panaccione R, Alberta Inflammatory Bowel Disease C. Phenotypic features of crohn’s disease associated with failure of medical treatment. Clin Gastroenterol Hepatol. 2014;12(434–42):e431.
28.
Zurück zum Zitat Peyrin-Biroulet L. Tumor necrosis factor inhibitors for inflammatory bowel disease. N Engl J Med. 2013;369:2561. CrossRefPubMed Peyrin-Biroulet L. Tumor necrosis factor inhibitors for inflammatory bowel disease. N Engl J Med. 2013;369:2561. CrossRefPubMed
29.
Zurück zum Zitat Tursi A, Elisei W, Picchio M, Zampaletta C, Pelecca G, Faggiani R, Brandimarte G. Comparison of the effectiveness of infliximab and adalimumab in preventing postoperative recurrence in patients with crohn’s disease: An open-label, pilot study. Tech Coloproctol. 2014;18:1041–6. CrossRefPubMed Tursi A, Elisei W, Picchio M, Zampaletta C, Pelecca G, Faggiani R, Brandimarte G. Comparison of the effectiveness of infliximab and adalimumab in preventing postoperative recurrence in patients with crohn’s disease: An open-label, pilot study. Tech Coloproctol. 2014;18:1041–6. CrossRefPubMed
30.
Zurück zum Zitat Orlando A, Mocciaro F, Renna S, Scimeca D, Rispo A, Lia Scribano M, Testa A, Aratari A, Bossa F, Tambasco R, Angelucci E, Onali S, Cappello M, Fries W, D’Inca R, Martinato M, Castiglione F, Papi C, Annese V, Gionchetti P, Rizzello F, Vernia P, Biancone L, Kohn A, Cottone M. Early post-operative endoscopic recurrence in crohn’s disease patients: Data from an italian group for the study of inflammatory bowel disease (ig-ibd) study on a large prospective multicenter cohort. J Crohns Colitis. 2014;8:1217–21. CrossRefPubMed Orlando A, Mocciaro F, Renna S, Scimeca D, Rispo A, Lia Scribano M, Testa A, Aratari A, Bossa F, Tambasco R, Angelucci E, Onali S, Cappello M, Fries W, D’Inca R, Martinato M, Castiglione F, Papi C, Annese V, Gionchetti P, Rizzello F, Vernia P, Biancone L, Kohn A, Cottone M. Early post-operative endoscopic recurrence in crohn’s disease patients: Data from an italian group for the study of inflammatory bowel disease (ig-ibd) study on a large prospective multicenter cohort. J Crohns Colitis. 2014;8:1217–21. CrossRefPubMed
31.
Zurück zum Zitat De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, Liew D, Prideaux L, Lawrance IC, Andrews JM, Bampton PA, Gibson PR, Sparrow M, Leong RW, Florin TH, Gearry RB, Radford-Smith G, Macrae FA, Debinski H, Selby W, Kronborg I, Johnston MJ, Woods R, Elliott PR, Bell SJ, Brown SJ, Connell WR, Desmond PV. Crohn’s disease management after intestinal resection: A randomised trial. Lancet. 2015;385:1406–17. CrossRefPubMed De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, Liew D, Prideaux L, Lawrance IC, Andrews JM, Bampton PA, Gibson PR, Sparrow M, Leong RW, Florin TH, Gearry RB, Radford-Smith G, Macrae FA, Debinski H, Selby W, Kronborg I, Johnston MJ, Woods R, Elliott PR, Bell SJ, Brown SJ, Connell WR, Desmond PV. Crohn’s disease management after intestinal resection: A randomised trial. Lancet. 2015;385:1406–17. CrossRefPubMed
Metadaten
Titel
Clinical and inflammatory response to first ileocolic resection for Crohn’s disease
An analysis of 117 cases
verfasst von
M.D. Hanna Ribbing Wilén
M.D., Ph.D. Per-Olof Nyström
M.D., Ph.D. Leif Törkvist
M.D., Ph.D. Johannes Blom
Publikationsdatum
01.08.2016
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2016
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-016-0426-0