Colectomy For Ulcerative Colitis Research Articles

Su1337 Disease Progression Is a Risk Factor for Colectomy in Ulcerative Colitis: 10-Years of Follow up in a Tertiary Care Facility

Su1337 Disease Progression Is a Risk Factor for Colectomy in Ulcerative Colitis: 10-Years of Follow up in a Tertiary Care Facility

Clinical course and predictors of total colectomy in ulcerative colitis; a referral center experience from Turkey.

We aimed to describe the clinical course of Ulcerative colitis (UC) and the factors that predict the need for total colectomy in Turkish patients with severe UC receiving regular follow up. We analyzed the demographic and clinical characteristics of 612 patients with UC receiving regular follow up between 1994 and 2010 in a tertiary referral center in Ankara. Men accounted for 58% of patients (M:F ratio, 1.4:1), and the mean age at diagnosis was 37.9 years. Of these, 32% had distal colitis and 8.8% had further extension, and 39 patients (6.4%) had chronic active disease. Steroid dependency and steroid resistance rates were 7.5% and 17.2%, respectively. In multivariate analysis, steroid dependency (p=0.04), steroid resistance (p=0.002), further extension (p<0.001), presence of extensive disease (p=0.006), and chronic active disease (p<0.001) were independent predictors of the need for total colectomy. Patients with chronic active disease had lower total colectomy free survival (p<0.001). The predictors of total colectomy were comparable with those previously reported in the literature. However, we identified further extension in disease localization to predict the need for total colectomy.

Neoplasia in the colorectal specimens of patients with ulcerative colitis and ileal pouch-anal anastomosis – need for routine surveillance?

Objective. Patients who undergo ileal pouch-anal anastomosis (IPAA) after colectomy for ulcerative colitis (UC) occasionally have neoplasia in the IPAA. Patients with evidence of dysplasia or carcinoma in the colorectal specimen may have an increased risk of such neoplasia. A surveillance program has been suggested. The aims of this study were to evaluate the outcomes of surveillance of a large patient cohort, and to investigate the prevalences of neoplasia in the ileal pouch mucosa and in the anal transitional zone (ATZ). Material and methods. A total of 629 patients underwent IPAA for UC at Sahlgrenska University Hospital, Gothenburg, Sweden. Identified from a register, 73 patients with neoplasia in their specimen considered eligible for the trial were prospectively enrolled, and underwent clinical examination, endoscopy with macroscopic evaluation, and mucosal biopsies from the ileal pouch and the ATZ. The biopsies were independently evaluated by two experienced gastro-pathologists. Results. In all, 56 patients (39 males) with a median follow-up time of 18 (range, 1–29) years were evaluated. One patient (1.8%; 95% CI 0%–5.3%) showed low-grade dysplasia in the pouch, as recorded by one of the two pathologists. The individual pathologists recorded indefinite for dysplasia (IFD) in the pouch for 19 and 20 patients, respectively, and IFD in the ATZ for 2 and 4 patients, respectively. None of the biopsies showed evidence of high-grade dysplasia (HGD) or carcinoma. Conclusions. Neoplasia in the ileal pouch or ATZ after IPAA for UC is rare in the proposed risk group. The necessity for and value of a routine surveillance program should be prospectively evaluated.

The impact of timing and duration of thiopurine treatment on colectomy in ulcerative colitis: a national population-based study of incident cases between 1989-2009.

The role of thiopurines in altering the risk of colectomy in ulcerative colitis (UC) remains unclear. To examine predictors of colectomy in UC and determine the impact of thiopurines on the risk of colectomy. We constructed a population-based cohort of incident cases of UC in the United Kingdom between 1989 and 2009. We determined trends in thiopurine usage and colectomy for three defined cohorts: era 1 (1989-1995), era 2 (1996-2002), era 3 (2003-2009). We used Cox regression to determine predictors of colectomy and quantified the impact of duration and timing of thiopurine use on the risk of colectomy. We identified 8673 incident cases of UC. 5-year colectomy rates increased from 4.2%, 5.1% to 6.9% (P=0.001) for era 1, era 2 and era 3, respectively, despite increasing thiopurine use. This was not significant after adjustment for predictors of colectomy (P=0.06). There was a higher risk of colectomy in men (HR 1.44, 95% CI: 1.19-1.73), those diagnosed at an early age (HR 1.35, 95% CI: 1.04-1.75; 16-24 vs. 25-64) and early steroid users (HR 1.94, 95% CI: 1.59-2.37). 5-ASA users were less likely to require a colectomy (HR 0.35, 95% CI: 0.28-0.44). Amongst thiopurine users, those treated for greater than 12months had a 71% reduction in risk of colectomy (HR 0.29, 95% CI: 0.21-0.40). Early thiopurines offered no additional benefit. Thiopurine exposure for greater than 12months reduces the likelihood of colectomy by 71%. Young men and those requiring steroids within 3months of diagnosis are at greatest risk of colectomy, and most likely to benefit from sustained thiopurine use.

Pustular psoriasis occurring after total colectomy for ulcerative colitis and relieved by administration of infliximab

Pustular psoriasis occurring after total colectomy for ulcerative colitis and relieved by administration of infliximab

Minimal access laparoscopic surgery for treatment of ulcerative colitis and familial adenomatous polyposis coli in children and adolescents.

Laparoscopic restorative proctocolectomy is standard surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis coli (FAP). Scar burden can be minimized by reducing the number of laparoscopic ports. The aim of this study is to review the authors' experience with reduced-port laparoscopy in this setting and to compare it with conventional laparoscopy using multiple ports. Charts of pediatric patients undergoing colectomy for UC or FAP between 2009 and 2012 were retrospectively reviewed. Patients who had the operation performed through one or two multichannel ports were assigned to the minimal access (MA) study group. Patients who had four or five single-channel ports with or without an additional small laparotomy were assigned to the LAP group. Twenty-two patients were identified. Ages at first operation were 2-18 years (median, 13.5 years). There were no conversions to laparotomy and no mortality. Mean operative times for the MA and LAP groups, respectively, were 250 and 284 minutes for abdominal colectomy with end ileostomy (P=.15), 198 and 301 minutes for completion proctectomy with diverting loop ileostomy (DLI) (P=.26), and 455 and 414 minutes for proctocolectomy with ileal pouch-anal anastomosis and DLI (P=.72). A major complication requiring laparotomy occurred in 1 patient (9%) in the MA group and in 2 patients (18%) in the LAP group. Minimal access laparoscopic surgery for UC and FAP is safe and feasible. A slightly larger incision at the ostomy site facilitates extraction of the specimen and extracorporeal construction of a J-pouch. Operative times and hospital stay are comparable to those with multiport laparoscopy.

Cyclosporine in steroid refractory acute severe colitis.

Approximately 15-20% patients with ulcerative colitis (UC) suffer from a severe flare during their lifetime which required hospitalization. Intravenous corticosteroids are the first line of therapy for acute severe UC. While almost 70-80% of patients respond to corticosteroids 20% do not. Although colectomy for UC is curative, it has its problems such as increased frequency of stool and pouchitis, which led to search for colon rescue therapy. Cyclosporine and anti-tumor necrosis factor-alpha (anti-TNF á) have emerged as effective colon rescue therapy. While the short-term efficacy of cyclosporine in preventing colectomy is 64-86%, the long-term efficacy is not as good and almost 70% eventually require colectomy over 1-7 years. The efficacy of cyclosporine is equivalent both at a high and low doses and cyclosporine is now used most often as a low dose regime in patients with steroid refractory acute severe UC. Furthermore, recent data suggest that the both cyclosporine and infliximab are equally effective in steroid refractory acute severe UC. Monitoring patients for adverse events and serum cyclosporine levels is mandatory. The response to both cyclosporine and infliximab is rapid and usually occurs within 4-5 days. Despite mounting evidence of its efficacy, cyclosporine remains largely underused because it requires intense monitoring for toxicity especially at higher dosage. Gastroenterologists need to be more familiar with cyclosporine for the management of steroid refractory acute severe UC.

Complications and surgery in the inflammatory bowel diseases biological era.

Therapy for inflammatory bowel diseases (IBD) has changed dramatically in recent years with a wider use of immunomodulators and the introduction of antitumor necrosis factor (anti-TNF) agents. This article reviews the existing data on the long-term efficacy of biologics, that is, anti-TNF agents, for preventing complications and surgery in patients with IBD. Anti-TNF agents are effective for preventing endoscopic and surgical recurrence after surgery for Crohn's disease. They are able to achieve fistula closure and do not increase the risk of stricture. Most randomized short-term trials also showed decreased requirement for hospitalizations and surgery in patients receiving anti-TNF. However, observational studies from referral centers or based on population have shown conflicting results. The need for surgery in Crohn's disease and the risk of colectomy in ulcerative colitis seem to be decreasing in recent years, but the specific effect of the introduction of anti-TNF agents cannot be currently evaluated. Although anti-TNF agents are the most powerful drugs in IBD, their ability to decrease the need for surgery remains unclear. Conflicting results observed in observational surveys might be because of anti-TNF agents administered too late in the course of IBD.

PWE-118 Predictors Of Colectomy And The Impact Of Thiopurines On The Risk Of Colectomy In Ulcerative Colitis – A National Uk Based Observational Study

IntroductionThiopurines (TPs) including azathioprine and mercaptopurine have an established role in maintaining disease remission in ulcerative colitis (UC) but their impact on the risk of colectomy remains unknown. Our aim...

Disease Course and Surgery Rates in Inflammatory Bowel Disease: A Population-Based, 7-Year Follow-Up Study in the Era of Immunomodulating Therapy

In this population-based 7-year follow-up of incident patients with ulcerative colitis (UC) or Crohn's disease (CD), we aimed to describe disease progression and surgery rates in an era influenced by the increased use of immunosuppressants and the introduction of biological therapy. From 1 January 2003 to 31 December 2004, all incident cases (562) of patients diagnosed with UC, CD, or inflammatory bowel disease unclassified in a well-defined Copenhagen area were registered. Medical records were reviewed from 1 November 2011 to 30 November 2012, and clinical data were registered. Clinical data on surgery, cancer, and death were cross-checked with register data from national health administrative databases in order to include missed data. In total, 513 patients (213 CD and 300 UC) entered the follow-up study. Twenty-six patients changed diagnosis during the follow-up. Changes in disease localization and behavior in CD according to the Vienna classification were observed in 23.9% and 15.0% of the patients, respectively, during follow-up. In total, 28.3% of the 300 UC patients had disease progression during the follow-up. The overall use of systemic steroids, immunomodulators, and anti-tumor necrosis factor agents in CD was 86.4%, 64.3%, and 23.5%, respectively. The rate of first-time intestinal resection in CD was 29.1% (n=62), and the 7-year cumulative risk was 28.5%. The cumulative risk of colectomy in UC was 12.5% at 7 years. UC and CD are dynamic diseases that progress in extent and behavior over time. The resection rate in CD and the colectomy rate in UC are still relatively high, although the rates seem to have decreased compared with historic data, which could be due to an increase in the use of immunomodulating therapy.

DOP038 Adolescent and young adults are more likely to require total colectomy in ulcerative colitis: UK population based cohort study

Background: It is hypothesized that younger age at diagnosis in patients with ulcerative colitis (UC) is associated with poor prognosis and severe disease. Our aim was to determine whether patients diagnosed at a younger age were more likely to have a total colectomy. Methods: We conducted a retrospective cohort study using electronic primary care records in the UK from the Clinical Practice Research Datalink (CPRD). We identified incident cases of UC between 1989 and 2009 in the CPRD which contains prescribing and clinical data for 13 million people in the UK and is a validated research database. Patients had to be registered for at least 12 months prior to diagnosis to be included. We stratified our cohort into four age categories; 65 years. We performed survival analysis using the Kaplan Meier method to obtain total colectomy rates by age category and present the results of a multivariate Cox-proportional hazards model. Log-rank testing was used to compare survival between groups. Results: Overall, 8673 patient met our inclusion criteria of which 479 went on to have a total colectomy during follow up. A large proportion of young patients aged 65 age groups respectively. The 3 year colectomy rates were 9.5% (95%CI: 6.2 14.4%), 7.9% (95%CI: 6.0 10.2%), 4.5% (95%CI: 4.0 5.2%) and 3.5% (95%CI: 2.6 4.6%) for the 65 age groups respectively (p < 0.001 via log-rank testing).

P520 Demographic features and long-term follow up outcome comparisons between patients with solo inflammatory bowel disease vs. inflammatory bowel disease and concomitant ankylosing spondylitis

Background: Aim of the study was to compare demographic features and the long term patient outcomes between inflammatory bowel disease (IBD) patients with and without ankylosing spondylitis (AS). Methods: An IBD clinic is run by our team since 1999 currently with 705 CD, 935 UC patients under the same registry. These patients’ files retrospectively were evaluated and 76 patients with IBD+AS [49 with Crohn’s disease (CD), 27 with ulcerative colitis (UC)] were identified and then each IBD+AS patient randomly was matched with the next two adjacent solo IBD patient with the same diagnosis so having 152 IBD (98 CD, 54 UC) patients as the control group. Besides comparing demographic features, the primary endpoint was to compare the rate of intestinal resections between both groups. Age at IBD and/or AS onset, age (if there is any) at resection, the mean follow up time, number of flares needing steroids, medications including the type, dosage and duration, presence of family history, sex, disease location, and behavior, presence of perianal fistulae, smoking status were noted. Patients with indeterminate colitis or AS patients developing intestinal inflammation under NSAID or biologic treatment were excluded. Results: AS significantly was more common in patients with CD (6.9%) than in patients with UC (2.8%) (p = 0.0001). Among 76 patients with IBD+AS, 52 (68%) first presented with IBD, 11 (15%) with AS, and the remaining 13 (17%) had both diagnoses at the same time. The mean age, age at diagnosis or at resection did not disclose any significant difference between both groups. Neither location nor behavior of IBD nor rate of perianal fistulae were different. The mean follow up time was significantly longer in patients with IBD+AS (44.49 vs 28.6mo; p = 0.0011), and the use of biologics, steroids significantly were more common among patients with IBD+AS (37% vs. 9% for biologics, p = 0.000; 43% vs. 28% for steroids, p = 0.026). 33 out of 152 (22%) IBD and 11 out of 76 (14%) IBD+AS patients underwent an intestinal resection (total colectomy for UC, resection for CD) during our follow up (p =NS). The Spearman correlation test identified significant relations between IBD duration, frequency of flares needing steroids and resection, but an age-sex adjusted regression analysis disclosed IBD duration as the only independent predictor for resection (R2 = 0.178; p = 0.016). Conclusions: The present study shows that up to 5% of IBD patients may have AS although it is twice more common in CD compared to UC patients. Patients with IBD+AS do not have a worse disease outcome than solo IBD patients. When both groups are analyzed together the only independent predictor for resection is the duration of IBD. P521 Cytomegalovirus infection and response to influenza vaccination in inflammatory bowel disease patients on anti-TNF therapy L. Guidi1 *, G. Andrisani1, D. Frasca2, P. Cattani3, M. Marzo1, C. Felice1, D. Pugliese1, A. Papa1, G.L. Rapaccini1, B.B. Blomberg2, A. Armuzzi1. 1Catholic University, IBD Unit, Complesso Integrato Columbus, Rome, Italy, 2Miller School of Medicine, Department of Microbiology and Immunology, Miami, United States, 3Catholic University, Clinical Laboratory Unit, Complesso integrato Columbus, Rome, Italy

Two Cases of Diffuse Airway Disease After Colectomy for Ulcerative Colitis

Two Cases of Diffuse Airway Disease After Colectomy for Ulcerative Colitis

Ileorectal anastomosis in comparison with ileal pouch anal anastomosis in reconstructive surgery for ulcerative colitis — a single institution experience

IntroductionIleal pouch anal anastomosis (IPAA) is the standard procedure for reconstruction after colectomy for ulcerative colitis (UC). However, ileorectal anastomosis (IRA) as an alternative has, recently experienced a revival. This study from a single center compares the clinical outcomes of these procedures. MethodsFrom 1992 to 2006, 253 patients consecutively underwent either IRA (n=105) or IPAA (n=148). Selection to either procedure was determined on the basis of rectal inflammation, presence of dysplasia/cancer or patient preferences. Patient-records were retrospectively evaluated. Mean follow-up time was 5.4 and 6.3years respectively. ResultsMajor postoperative complications occurred in 12.4% of patients after IRA and in 12.8% after IPAA (ns). Complications of any kind after IRA or IPAA, even including subsequent stoma-closure, occurred in 23.8% and 39.9% respectively (p<0.01). Estimated cumulative failure rates after 5 and 10years were 10.1% and 24.1% for IRA and 6.1% and 18.6% for IPAA respectively (ns). The most common cause for failure was intractable proctitis (4.8%) and unspecified dysfunction (4.8%) respectively. At follow-up 76.9% of patients with IRA had proctitis and 34.1% with IPAA had pouchitis. Estimated cumulative cancer-risk after 10, 20 and 25year duration of disease was 0.0%, 2.1% and 8.7% for IRA. Figures for IPAA were 0.7%, 1.8% and 1.8% (ns). ConclusionFailure-rates did not significantly differ between patients operated with IRA or IPAA. Patients operated with IPAA had a higher cumulative number of postoperative complications. The high long-term cancer-risk after IRA indicates that this procedure should be an interim solution in younger patients.

A retrospective study reviewing the fate of the rectum after total abdominal colectomy and end ileostomy in patients with ulcerative colitis

Aim The objective of this study was to review the fate of the rectal stump following total colectomy for ulcerative colitis and evaluate the risk of rectal cancer.

Crohnʼs Disease Diagnosed after Colectomy for Ulcerative Colitis: Can We Predict and Avoid this Situation before Surgery?

Crohnʼs Disease Diagnosed after Colectomy for Ulcerative Colitis: Can We Predict and Avoid this Situation before Surgery?

Genetic variants of membrane metallopeptidase genes in inflammatory bowel diseases

The substance P pathway modulates neuroimmune interactions during intestinal inflammation. To analyse mucosal expression and genetic variants of the genes coding for substance P, neurokinin-1 receptor and neutral endopeptidase in patients with inflammatory bowel disease. qRT-PCR was used to analyse mRNA levels in matched, paired samples of inflamed colonic mucosa and adjacent non-inflamed endoscopic tissue from 26 Crohn's disease and 25 ulcerative colitis patients. Allele and genotype frequencies of tag-SNPs were determined in 908 Crohn's disease, 929 ulcerative colitis, and 853 controls. Expression levels and genotype distributions were examined within patients' clinical sub-phenotypes. All 3 evaluated genes were overexpressed in inflamed tissues from Crohn's disease (P=0.033, P=4×10(-5), P=0.001), while in ulcerative colitis only higher levels of the gene coding for neutral endopeptidase were statistically significant (P=2.5×10(-5)). Smoking habit and perianal disease were significantly associated with substance P (P=0.002) and neurokinin-1 receptor levels (P=0.02) in Crohn's disease. Neutral endopeptidase rs701109 variant was associated with inflammatory bowel disease (Crohn's disease: P=0.022; ulcerative colitis: P=0.045), and with the need for colectomy in ulcerative colitis (P=0.008, OR=2.46, 95% CI=1.27-4.76). Genetic variants of the gene coding for neutral endopeptidase might affect the neuroimmune interaction during intestinal inflammation and influence clinical sub-phenotypes in patients with inflammatory bowel disease.

Serum Antibodies Associated with Complex Inflammatory Bowel Disease

Antibodies to microbial antigens have been associated with specific diagnoses and phenotypes of inflammatory bowel disease. We evaluated the prevalence of pANCA, IgA and IgG anti-Saccharomyces cerevisiae antibodies, anti-OmpC, and anti-flagellin in a large well-defined population of patients with Crohn's disease (CD) and ulcerative colitis (UC) and analyzed for various clinical outcomes. Samples were collected from 391 patients with CD, 207 patients with UC, and 62 healthy controls. Patients were phenotyped using the Montreal classification. Blinded serological analyses were performed for pANCA, IgA and IgG anti-Saccharomyces cerevisiae antibodies, anti-OmpC, and anti-flagellin. In CD, increasing quantitative levels for antibodies were associated with a younger age of diagnosis, longer disease duration, increased surgeries, ileocolonic and perianal disease, and internal perforating behavior. In UC, they were associated with colectomy. An increasing number of seropositive antibodies in CD was associated with a younger age at diagnosis, increased disease duration, ileocolonic and perianal disease, internal penetrating and stricturing behavior, and increased surgeries. Multivariate analysis confirmed the association of antimicrobial antibodies with features of complicated CD and UC. Increased serological markers are associated with a more aggressive CD phenotype and an increased need for colectomy in UC. This raises the possibility for use of these markers in patients at risk of complex disease.

1006 Increased Mortality Associated With Chronic Medical Therapy Versus Elective Colectomy in Ulcerative Colitis

1006 Increased Mortality Associated With Chronic Medical Therapy Versus Elective Colectomy in Ulcerative Colitis

565 Appendectomy and Extensive Disease Are Independent Predictors of Colectomy in Ulcerative Colitis: Results From a Large Cross-Sectional Cohort

565 Appendectomy and Extensive Disease Are Independent Predictors of Colectomy in Ulcerative Colitis: Results From a Large Cross-Sectional Cohort