Risk of early surgery for Crohn's disease: implications for early treatment strategies

Sands, Bruce E.; Arsenault, Joanne E.; Rosen, Michael J.; Alsahli, Mazen; Bailen, Laurence; Banks, Peter; Bensen, Steven; Bousvaros, Athos; Cave, David; Cooley, Jeffrey S.; Cooper, Herbert L.; Edwards, Susan T.; Farrell, Richard J.; Griffin, Michael J.; Hay, David W.; John, Alex; Lidofsky, Sheldon; Olans, Lori B.; Peppercorn, Mark A.; Rothstein, Richard I.
December 2003
American Journal of Gastroenterology;Dec2003, Vol. 98 Issue 12, p2712
Academic Journal
OBJECTIVES: In this study we aimed to define the rate of early surgery for Crohn's disease and to identify risk factors associated with early surgery as a basis for subsequent studies of early intervention in Crohn's disease. METHODS: We assembled a retrospective cohort of patients with Crohn's disease diagnosed between 1991 and 1997 and followed for at least 3 yr, who were identified in 16 community and referral-based practices in New England. Chart review was performed for each patient. Details of baseline demographic and disease features were recorded. Surgical history including date of surgery, indication, and procedure were also noted. Risk factors for early surgery (defined as major surgery for Crohn's disease within 3 yr of diagnosis, exclusive of major surgery at time of diagnosis) were identified by univariate analysis. Multiple logistic regression was used to identify independent risk factors. RESULTS: Of 345 eligible patients, 69 (20.1%) required surgery within 3 yr of diagnosis, excluding the 14 patients (4.1%) who had major surgery at the time of diagnosis. Overall, the interval between diagnosis and surgery was short; one half of all patients who required surgery underwent operation within 6 months of diagnosis. Risk factors identified by univariate analysis as significantly associated with early surgery included the following: smoking; disease of small bowel without colonic involvement; nausea and vomiting or abdominal pain on presentation; neutrophil count; and steroid use in the first 6 months. Disease localized to the colon only, blood in the stool, use of 5-aminosalicylate, and lymphocyte count were inversely associated with risk of early surgery. Logistic regression confirmed independent associations with smoking as a positive risk factor and involvement of colon without small bowel as a negative risk factor for early surgery. CONCLUSIONS: The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that improved risk stratification and potent therapies with rapid onset of action are needed to modify the natural history of Crohn's disease.


Related Articles

  • Nonfamilial Turcot's Syndrome Associated with Crohn's Disease and Duodenal Ulcer in One Kindred. Scapa, E.; Umlas, J.; Loewenstein, M. S.; Zamcheck, N. // American Journal of Gastroenterology;Jul1983, Vol. 78 Issue 7, p411 

    We report a case of Turcot's syndrome in a 56-year-old man with nonfamilial polyposis coli and Dukes C adenocarcinoma of the colon who later manifested a grade 3 astrocytoma of the brain. His daughter has well-documented Crohn's disease of the small and large bowel and his son suffered from a...

  • A Key Role for E-cadherin in Intestinal Homeostasis and Paneth Cell Maturation. Schneider, Marlon R.; Dahlhoff, Maik; Horst, David; Hirschi, Benjamin; Trülzsch, Konrad; Müller-Höcker, Josef; Vogelmann, Roger; Allgäuer, Michael; Gerhard, Markus; Steininger, Sylvia; Wolf, Eckhard; Kolligs, Frank T. // PLoS ONE;2010, Vol. 5 Issue 12, p1 

    Background: E-cadherin is a major component of adherens junctions. Impaired expression of E-cadherin in the small intestine and colon has been linked to a disturbed intestinal homeostasis and barrier function. Down-regulation of Ecadherin is associated with the pathogenesis of infections with...

  • Cigarette Smoking in Crohn's Disease. Silverstein, Marc D.; Lashner, Bret A.; Hanauer, Stephen B.; Evans, Alison A.; Kirsner, Joseph B. // American Journal of Gastroenterology;Jan1989, Vol. 84 Issue 1, p31 

    Crohn's disease is a chronic disease of unknown etiology. Previous reports have suggested that cigarette smoking may he associated with the development of Crohn's disease. To examine this association, we conducted a case-control study of patients referred to a single practice over a 7-month...


    Crohn's disease has been associated with reduced ability to recruit neutrophils to sites of trauma. Six patients with Crohn's disease were compared to 8 controls, approximately matched for age, sex, and smoking history. No patient was taking immunosuppressive or anti-inflammatory medication....

  • Diagnosing small bowel Crohn's disease with wireless capsule endoscopy. Fireman, Z.; Mahajna, E.; Broide, E.; Shapiro, M.; Fich, L.; Sternberg, A.; Kopelman, Y.; Scapa, E. // Gut;Mar2003, Vol. 52 Issue 3, p390 

    Background: The small bowel is the most commonly affected site of Crohn's disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy. Aims: To evaluate, for the first time, the effectiveness of...

  • Interleukin-8 and SDF1 -α mRNA Expression in Colonic Biopsies From Patients With Inflammatory Bowel Disease. Katsuta, Takeshi; Lim, Christina; Shimoda, Katsuhiro; Shibuta, Kenji; Mitra, Prasenjit; Banner, Barbara F.; Mori, Masaki; Barnard, Graham F. // American Journal of Gastroenterology;Nov2000, Vol. 95 Issue 11, p3157 

    OBJECTIVES: Interleukin-8 (IL-8) as an α-chemokine recruits and activates neutrophils, which are abundant in the intestinal lesions of ulcerative colitis (UC) and Crohn's disease (CD). Stromal cell-derived factor 1 (SDF1-α) is a new chemokine that is chemotactic to neutrophils. The aims of...

  • Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease. Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo; Pique, Josep M. // World Journal of Gastroenterology;7/28/2009, Vol. 15 Issue 28, p3504 

    AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). METHODS: Three hundred and forty...

  • New Studies on the Role of Smoking in Inflammatory Bowel Disease: Are We Not Beating a Dead Horse? Picco, Michael F. // American Journal of Gastroenterology;Mar2007, Vol. 102 Issue 3, p598 

    The role of smoking in inflammatory bowel disease (IBD) has drawn more interest as our understanding of these diseases has moved beyond the simple designations of Crohn's disease (CD) and ulcerative colitis (UC). In this issue of the journal, Aldous et al. present two papers on the role of...

  • Biorelevant Media to Simulate Fluids in the Ascending Colon of Humans and Their Usefulness in Predicting Intracolonic Drug Solubility. Vertzoni, Maria; Diakidou, Amalia; Chatzilias, Manos; Söderlind, Erik; Abrahamsson, Bertil; Dressman, Jennifer B.; Reppas, Christos // Pharmaceutical Research;Oct2010, Vol. 27 Issue 10, p2187 

    Purpose: To develop media simulating human colonic fluids (HCFs), to evaluate their use in predicting intracolonic solubility of ketoconazole, danazol and felodipine and to compare solubilities in HCFs with previously determined solubilities in gastric (HGFs) and small intestinal (HIFs) fluids....


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics