Mild neoterminal ileal post-operative recurrence of Crohn's disease conveys higher risk for severe endoscopic disease progression than isolated anastomotic lesions.
Mild neoterminal ileal post-operative recurrence of Crohn's disease conveys higher risk for severe endoscopic disease progression than isolated anastomotic lesions.
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DOI：
10.1111/apt.16804
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发表时间：
2022-05
影响因子：
7.6
通讯作者：
Click, Benjamin H.
中科院分区：
文献类型：
--
作者：
Bachour, Salam P.;Shah, Ravi S.;Lyu, Ruishen;Rieder, Florian;Qazi, Taha;Lashner, Bret;Achkar, Jean Paul;Philpott, Jessica;Barnes, Edward L.;Axelrad, Jordan;Holubar, Stefan D.;Lightner, Amy L.;Regueiro, Miguel;Cohen, Benjamin L.;Click, Benjamin H.
在评估孤立性术后吻合口炎症对未来疾病进展的影响时，存在相互矛盾的数据。本研究的目的是确定术后患有孤立性吻合疾病的克罗恩病患者发生严重疾病进展的相对风险。 2009-2020 年接受回结肠切除术的成年克罗恩病患者的回顾性队列研究。纳入术后 18 个月以内接受回肠结肠镜检查且随后接受 ≥1 次回肠结肠镜检查的患者。使用改良的 Rutgeerts 评分评估疾病活动性。主要结局是在随后的回肠结肠镜检查和整个术后随访期间严重的内镜进展，定义为 i3 或 i4 疾病。次要结局是手术复发。 199 名克罗恩病患者在手术后 18 个月内接受了回肠结肠镜检查，Rutgeerts 评分为 i0-i2b，并且随后进行了≥1 次回结肠镜检查。在首次回肠结肠镜检查中，34.7% 患有 i0 疾病，16.1% 患有 i1 疾病，24.6% 有 i2a 疾病，24.6% 有 i2b 疾病。在多变量逻辑回归中，与 i0 或 i1（aOR 5.53；p<0.001）和 i2a 疾病患者（aOR 2.63；p=0.03）相比，i2b 疾病与严重内镜进展相关。然而，与 i0 或 i1 疾病相比，i2a 疾病并未增加风险 (p=0.09)。此外，i2b 患者经历严重内镜进展的时间明显早于 i0 或 i1 疾病（aHR 4.68；p<0.001），而 i2a 疾病与 i0 或 i1 疾病没有差异（p=0.25）。手术复发与 Rutgeerts 评分 i0-i2b 指数无关（p=0.86）。术后回肠疾病复发，而不是孤立的吻合口炎症，会增加严重内镜下疾病进展的风险。克罗恩病复发的位置可能会影响最佳的治疗策略。
There is conflicting data assessing the impact of isolated postoperative anastomotic inflammation on future disease progression. The aim of this study was to determine the relative risk of severe disease progression in postoperative Crohn’s disease patients with isolated anastomotic disease. Retrospective cohort study of adult Crohn’s disease patients undergoing ileocolonic resection between 2009-2020. Patients with a postoperative ileocolonoscopy ≤18 months from surgery and ≥1 subsequent ileocolonoscopy were included. Disease activity was assessed using the modified Rutgeerts’ score. Primary outcome was severe endoscopic progression, defined as i3 or i4 disease, on immediate subsequent ileocolonoscopy and during entire postoperative follow up. Secondary outcome was surgical recurrence. 199 Crohn’s disease patients had an ileocolonoscopy ≤18 months from surgery, index Rutgeerts’ score of i0-i2b, and ≥1 subsequent ileocolonoscopy. At index ileocolonoscopy, 34.7% had i0 disease, 16.1% i1, 24.6% i2a, and 24.6% i2b. On multivariable logistic regression, i2b disease was associated with severe endoscopic progression compared to i0 or i1 (aOR 5.53; p<0.001) and i2a disease patients (aOR 2.63; p=0.03). However, i2a disease did not confer increased risk compared to i0 or i1 disease (p=0.09). Furthermore, i2b patients experienced severe endoscopic progression significantly earlier than i0 or i1 disease (aHR 4.68; p<0.001), whereas i2a disease did not differ from i0 or i1 disease (p=0.25). Surgical recurrence was not associated with index Rutgeerts’ score i0-i2b (p=0.86). Postoperative ileal disease recurrence, not isolated anastomotic inflammation, confers increased risk for severe endoscopic disease progression. Location of Crohn’s disease recurrence may impact optimal management strategies.
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影响因子：
3.1
作者：
Kim, Jin Yong;Park, Sang Hyoung;Yang, Suk-Kyun
通讯作者：
Yang, Suk-Kyun
影响因子：
4.3
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Nos, Pilar;Domenech, Eugeni
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Domenech, Eugeni
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RUTGEERTS, P;GEBOES, K;COREMANS, G
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COREMANS, G
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TORSOLI, A
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