Management Of Crohn's Disease Patients Research Articles

The Role of Chronic Fatigue in Patients with Crohn's Disease.

Crohn's disease (CD) is a chronic, relapsing disorder belonging to inflammatory bowel diseases (IBD). It is manifested by relapsing transmural inflammation found in any segment of the gastrointestinal tract. Chronic fatigue is a common and underrecognized symptom of CD for which the prevalence is much higher in the population of CD patients compared to the healthy population. It stems from an intricate web of interactions between various risk factors, and its pathophysiology is still not fully understood. The implementation of routine screening and a holistic, multidisciplinary approach involving psychological support may be crucial in the management of CD patients with chronic fatigue. There is currently no single intervention aimed at decreasing fatigue alone, and its treatment is especially difficult in patients with fatigue persisting despite clinical and endoscopic remission. Extensive research is still needed in order to be able to predict, prevent, identify, and ultimately treat fatigue associated with CD. The aim of this review is to summarize the knowledge on the etiology, diagnosis, and treatment of chronic fatigue in CD patients.

Is fecal calprotectin an accurate marker in the management of Crohn's disease?

Although lacking validated cutoff values, fecal calprotectin (FC), besides C-reactive protein, is considered the standard test for assessing disease activity in Crohn's disease (CD). The aim of the present review is to provide a general overview of the literature addressing the role of FC in the clinical and endoscopic assessment of disease activity in CD, seeking correlations with capsule endoscopy, response to therapy, prediction of relapse, and postoperative recurrence. A systematic search of the literature up to September 2019 was performed using Medline, Embase, and the Cochrane Library. Only papers written in English concerning FC in adult patients affected by CD were included. Pediatric studies, in vitro studies, animal studies, studies on blood/serum samples, and studies analyzing FC in ulcerative colitis or in both CD and ulcerative colitis were excluded. Out of 713 citations, 65 eligible studies were identified. FC showed high accuracy in the assessment of intestinal inflammation and response to therapy, in particular in colonic disease, thus proving a good surrogate marker for these aims. FC is useful in identifying patients at high risk for endoscopic relapse or postoperative recurrence, for optimizing or downstage therapy. Unfortunately, FC performs less well in small bowel CD. FC is an effective fecal marker in the management of CD patients, optimizing the use of endoscopic procedures. Owing to its diagnostic accuracy, FC may represent a cornerstone of the "treat-to-target" management strategy of CD patients.

OP013 Disease management and outcomes of patients with Crohn's disease at high risk of recurrence. Results from PRACTICROHN study

Background: Surgery in Crohn disease (CD) is associated with poor prognosis and higher rate of clinical and surgical recurrence. The aim of our study was to compare the characteristics and management of CD patients that have undergo one surgery with patients that have undergo more than one surgery. Methods: PRACTICROHN was an observational study that included patients aged ≥18 years-old from 26 spanish hospitals who underwent CD-related resection with ileocolonic or ileorectal anastomosis between January 2007 and December 2010. Patient data were retrospectively collected from medical records. Categorical variables were compared with the χ2 test or Fisher's exact test. Kaplan-Meier method was used to assess time to clinical recurrence and a log-rank test to obtain statistical significance. Results: 314 patients were analyzed, 262 (83%)were included in the first surgery (50% males) and 52 (16%) referred previous surgeries (36% males). Mean age at diagnosis was similar in the first surgery group (FSG) (33±14 years) vs second surgery group (SSG). Age at index surgery was 39±13 years in FSG vs 43±12 in SSG, p=0.021. Smoking habit was higher in FSG vs SSG (41% vs 34%, p=0.47). Montreal classification in the two groups were similar except for behavior, with higher proportion of patients with B1 in FSG vs SSG (124 (48%) vs 13 (28%)) and higher proportion of B2 and B3 in SSG (74 (29%) B2 in FSG vs 21 (46%) in SSG and 57 (22%) B3 in FSG vs 12 (26%) in SSG), p=0.027. Regarding treatment, 33 (13%) patients in the FSG received steroids previous to surgery vs 13 (27%) patients in the SSG. p=0.029. No difference in IMM and biological treatment previous to surgery was found between the two groups. After surgery, a higher proportion of patients received prophylactic treatment with IMM in the SSG compared with FSG p=0.012. No difference in the rate of colonoscopies performed during first year after surgery was found between the two groups as well as in the findings at the colonoscopies. Hospitalizations and postoperative complications were also similar. There was no diference in clinical recurrence in SSG in patients receiving or not prophylaxis (p=0.5) whereas in FSG clinical recurrence-free survival was greater in patients with prophylactic treatment (p=0.03) (Fig. 1). Figure 1. Time to disease recurrence in FSG vs SSG. Conclusions: In our sample, although patients in SSG were less smokers and received more prophylaxis with IMM and similar post surgery follow-up, they presented more clinical recurrence. This confirms that undergoing a second surgery is a main factor of poor prognosis.

Colitis cystica profunda indefinite for dysplasia in Crohn disease: A potential diagnostic pitfall

Colitis cystica profunda (CCP) is a nonneoplastic condition characterized by misplaced glands deep to the muscularis mucosae of the colon and may be difficult to differentiate from well-differentiated mucinous adenocarcinoma. Absence of dysplasia in CCP usually aids in this distinction. We present a challenging case of CCP in the setting of Crohn disease (CD) containing foci of atypical epithelium. A right hemicolectomy from a 46-year-old woman contained a stricture associated with a proximal multilocular cystic lesion containing mucin-filled glands dissecting through the colonic wall. These glands had lobulated architecture with smooth contours surrounded by lamina propria and lacking desmoplastic stroma. The epithelium had focal nuclear crowding, enlargement, and hyperchromasia, with increased nucleus to cytoplasm ratio, but overall preserved polarity. Atypical cells were focally positive for CK7 and p53, with increased MIB-1 staining. These findings were interpreted as indefinite for dysplasia. Chronic transmural inflammation and mucosal regeneration probably facilitated epithelial misplacement, which secondarily developed cytologic atypia. However, the overall architecture and lack of dysplasia in the overlying mucosa argue against a diagnosis of adenocarcinoma. Our case illustrates the difficult diagnosis of this uncommon but problematic phenomenon, awareness of which is paramount for pathologists and clinicians participating in the management of CD patients.

PTU-106 A prospective single centre evaluation of the intra-individual variability of faecal calprotectin in quiescent Crohn's disease patients

IntroductionFaecal calprotectin (FC) has become an established non-invasive, sensitive marker of intestinal inflammation in Crohn's disease (CD). A single measurement of FC is used in clinical practice to aid decision...