Abstract
BackgroundSixty percent of Crohn’s disease (CD) patients require intestinal resection, and 20% of ulcerative colitis (UC) patients undergo proctocolectomy for medically refractory disease. Scarcity of literature about predictors for surgical intervention in inflammatory bowel disease (IBD) encouraged the conduction of this study to assess risk factors for surgical intervention in IBD patients.ResultsThis cohort study included 80 Egyptian inflammatory bowel disease patients recruited from two medical centers. Patients were classified into two groups, 40 patients each, according to their need for surgical intervention to control inflammatory bowel disease. The two groups were compared regarding age of onset, type and location of disease, smoking, extraintestinal manifestations, perianal disease, granuloma, severity scores, stool calprotectin, complete blood count, erythrocyte sedimentation rate, C-reactive protein, and serum albumin at diagnosis for Crohn’s disease patients.Twelve ulcerative colitis and 28 Crohn’s disease patients required surgical intervention in the form of total colectomy (30%), fistulectomy (32.5%), resection anastomosis (17.5%) or abscess drainage (20%). Perianal disease, smoking, and disease severity scores showed high significant differences (P value < 0.001); disease type and presence of granuloma showed statistically significant difference (P value < 0.05) between both groups. But, patient age at onset, location of the disease or extraintestinal manifestation had no statistical significance (P value > 0.5). Surgical interventions were more likely to be needed in patients with higher stool calprotectin level, C-reactive protein, erythrocyte sedimentation rate, and lower serum albumin for Crohn’s disease patients (P value < 0.001 for each).ConclusionSmoking, perianal disease, higher severity scores, stool calprotectin, C-reactive protein, and erythrocyte sedimentation rate levels are predictors of surgical treatment.
Highlights
Sixty percent of Crohn’s disease (CD) patients require intestinal resection, and 20% of ulcerative colitis (UC) patients undergo proctocolectomy for medically refractory disease
Toxic megacolon should be suspected in inflammatory bowel disease (IBD) patients presenting with abdominal distension and diarrhea, clinical signs of systemic toxicity combined with radiographic evidence of colonic dilatation are diagnostic
The 40 patients enrolled in the surgical group were found to be 12 patients (30%) with UC and 28 patients (70%) with CD; those patients had either total colectomy (12patients [30%]), fistulectomy (13 patients [32.5%]), resection anastomosis (7 patients [17.5%]), or abdominal abscess drainage (8 patients [20%])
Summary
Sixty percent of Crohn’s disease (CD) patients require intestinal resection, and 20% of ulcerative colitis (UC) patients undergo proctocolectomy for medically refractory disease. Severe bleeding in up to 10% of UC patients, fistulae, peritonitis, abscess, intestinal obstruction in Crohn’s disease patients as well as intestinal perforation and toxic megacolon are indications of surgery in IBD patients. If there was no response within 3 days in the form of less toxic patient, decreased fluid and transfusion requirements, resolution of abdominal and colonic dilatation with improvement of abnormal laboratory findings, and the patient. In case of abscess formation, antibiotics with percutaneous drainage for abscesses > 2 cm in diameter with optimization of Crohn’s therapy are usually required, yet there may be recurrence of the abscess, so surgical resection of the diseased bowel is frequently needed [2]
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