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Recurrence of Crohn's disease after total colectomy with permanent ileostomy

The latest issue of the Alimentary Pharmacology & Therapeutics evaluated the rate, risk factors and outcomes of Crohn's disease recurrence after total colectomy or proctocolectomy with permanent ileostomy.

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Subtotal or total colectomy or proctocolectomy with permanent ileostomy may be a treatment option for medically refractory colonic Crohn's disease.

Dr Singh and colleagues from California, USA performed a systematic review and meta-analysis to evaluate the rate, risk factors and outcomes of Crohn's disease recurrence after total colectomy or proctocolectomy with permanent ileostomy.

In a systematic review ending 2016, the team identified 18 cohort studies who underwent total colectomy or proctocolectomy with permanent ileostomy for colonic Crohn's disease. 

The researchers estimated pooled rates of clinical and surgical recurrence, and risk factors for disease recurrence.

The research team found that the risk of clinical recurrence after total colectomy or proctocolectomy with permanent ileostomy was 28%, with a 5 and 10-year median cumulative rate of 24%, and 40%, respectively. 
The risk of clinical recurrence in patients without ileal disease at baseline was 12%
Alimentary Pharmacology & Therapeutics

The team noted that the risk of surgical recurrence was 16%, with a 5 and 10-year median cumulative rate of 10%, and 19%, respectively. 

The risk of clinical and surgical recurrence in patients without ileal disease at baseline was 12%, and 10%, respectively. 

The researchers observed that the history of ileal disease was associated with 3 times higher risk of disease recurrence. 

Other inconsistent risk factors for disease recurrence were penetrating disease and young age at disease onset.

Dr Singh's team concludes, "Small bowel clinical recurrence occurs in about 28% of patients after total colectomy with permanent ileostomy for colonic Crohn's disease."

"Disease recurrence risk is 3 times higher in patients with history of ileal disease, and continued medical therapy may be advisable in this population."

"In patients without ileal inflammation at surgery, continued endoscopic surveillance may identify asymptomatic disease recurrence to guide therapy."

Aliment Pharmacol Ther 2017: 45(3): 381–390 
05 January 2017

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