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Outcomes with Anti-Tumour Necrosis Factor-Alpha Therapy and Serology in Patients with Denovo Crohn's Disease After Ileal Pouch Anal Anastomosis
- Source :
- Journal of Crohn'scolitis. 11(1)
- Publication Year :
- 2016
-
Abstract
- Background and Aims: A subset of patients who undergo ileal pouch-anal anastomosis [IPAA] for ulcerative colitis [UC] will later be diagnosed with denovo Crohn’s disease [CD]. These patients have a higher risk of pouch failure. In this study we evaluated inflammatory bowel disease [IBD] serology in patients with denovo CD and examined the success of anti-tumour necrosis factor-alpha [anti-TNFα] therapy in preventing ileostomy in denovo CD patients who failed anti-TNFα therapy before IPAA. Methods: A prospectively maintained database of patients undergoing IPAA was reviewed to identify patients who developed denovo CD [defined as small bowel inflammation above the pouch inlet or pouch fistula/perianal disease appearing more than 3 months after stoma closure]. Clinical characteristics and IBD serology were analysed. Treatment failure was defined as pouch failure requiring ileostomy or pouchectomy. Results: Of 350 patients included in the study, 92 [26%] patients developed denovo CD. Significantly more denovo CD patients had anti-I2 positivity postoperatively versus preoperatively [ p = 0.007]. Anti-TNFα therapy successfully treated denovo CD in 28 out of 38 [74%] patients. Out of 17 patients with denovo CD who had failed to respond to anti-TNFα agents before surgery and were treated with anti-TNFα therapy after surgery, 12 [71%] patients responded to treatment. Conclusions: I2 serology may possibly help identify patients who have developed or are at risk for developing denovo CD. Anti-TNFα therapy for denovo CD after IPAA can help prevent permanent ileostomy in almost 75% of cases, even in patients who previously failed anti-TNFα treatment before surgery.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Fistula
Colonic Pouches
Anastomosis
Gastroenterology
Inflammatory bowel disease
Serology
03 medical and health sciences
Ileostomy
Young Adult
0302 clinical medicine
Crohn Disease
Internal medicine
Medicine
Humans
Prospective Studies
Child
Aged
Crohn's disease
business.industry
Tumor Necrosis Factor-alpha
General Medicine
Middle Aged
medicine.disease
Ulcerative colitis
Surgery
Treatment Outcome
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
Pouch
business
Subjects
Details
- ISSN :
- 18764479
- Volume :
- 11
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of Crohn'scolitis
- Accession number :
- edsair.doi.dedup.....9dd90ea42a10f2c90ab21cce19d07125