Histology at diagnostic gastroscopy predicts outcome after intestinal resection in pediatric Crohn's disease.
Crohn's disease
endoscopy-upper GI
inflammatory bowel disease: clinical trials
pediatric disorders
surgery
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
04
09
2019
revised:
15
04
2020
accepted:
24
04
2020
pubmed:
29
4
2020
medline:
31
7
2021
entrez:
29
4
2020
Statut:
ppublish
Résumé
Pediatric Crohn's disease (CD) has been shown to have a high recurrence rate following surgical resection. Risk factors for postoperative CD recurrence in children are not well known. The aim of this study was to identify factors influencing postoperative recurrence in pediatric CD. Pediatric CD patients who underwent surgical resection with primary anastomosis with a minimum follow up of 2 years were identified from databases at the Royal London Hospital and Massachusetts General Hospital. Patients were subdivided into a recurrence group defined by clinical, endoscopic, histological, radiological and/or surgical outcomes, and a nonrecurrence group. Patient demographics, initial gastroscopy and colonoscopy findings, Paris classification, and preoperative and postoperative pharmacotherapy were analyzed. Ninety-six children who underwent an ileal or ileocolonic resection with primary anastomosis were identified. Fifty-seven children had postoperative recurrence. Recurrence was associated with abnormal initial gastroscopy findings (P = 0.0077), ileocolonic disease location (P = 0.03), and perianal disease involvement (P = 0.04). Patients with abnormal initial gastroscopy had higher rates of relapse (hazard ratio 3.42, 95% confidence interval [CI] [1.86-6.30], P = 0.001). Multivariate analysis demonstrated that abnormal diagnostic gastroscopy histology was a significant independent predictor of postoperative recurrence in this cohort (odds ratio 1.33, 95% CI [1.04-1.70], P = 0.024). The most common histological abnormality was non-Helicobacter gastritis, found in 29/46 (63%). This dual-center study has shown that the presence of upper gastrointestinal tract inflammation, especially non-Helicobacter gastritis, at the time of diagnosis, is associated with an increased risk of postoperative recurrence in pediatric CD.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Pediatric Crohn's disease (CD) has been shown to have a high recurrence rate following surgical resection. Risk factors for postoperative CD recurrence in children are not well known. The aim of this study was to identify factors influencing postoperative recurrence in pediatric CD.
METHODS
METHODS
Pediatric CD patients who underwent surgical resection with primary anastomosis with a minimum follow up of 2 years were identified from databases at the Royal London Hospital and Massachusetts General Hospital. Patients were subdivided into a recurrence group defined by clinical, endoscopic, histological, radiological and/or surgical outcomes, and a nonrecurrence group. Patient demographics, initial gastroscopy and colonoscopy findings, Paris classification, and preoperative and postoperative pharmacotherapy were analyzed.
RESULTS
RESULTS
Ninety-six children who underwent an ileal or ileocolonic resection with primary anastomosis were identified. Fifty-seven children had postoperative recurrence. Recurrence was associated with abnormal initial gastroscopy findings (P = 0.0077), ileocolonic disease location (P = 0.03), and perianal disease involvement (P = 0.04). Patients with abnormal initial gastroscopy had higher rates of relapse (hazard ratio 3.42, 95% confidence interval [CI] [1.86-6.30], P = 0.001). Multivariate analysis demonstrated that abnormal diagnostic gastroscopy histology was a significant independent predictor of postoperative recurrence in this cohort (odds ratio 1.33, 95% CI [1.04-1.70], P = 0.024). The most common histological abnormality was non-Helicobacter gastritis, found in 29/46 (63%).
CONCLUSION
CONCLUSIONS
This dual-center study has shown that the presence of upper gastrointestinal tract inflammation, especially non-Helicobacter gastritis, at the time of diagnosis, is associated with an increased risk of postoperative recurrence in pediatric CD.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2074-2079Informations de copyright
© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. The natural history of adult Crohn's disease in population-based cohorts. Am J Gastroenterol 2010; 105: 289-297.
Mowat C, Arnott I, Cahill A et al. Mercaptopurine versus placebo to prevent recurrence of Crohn's disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial. Lancet Gastroenterol Hepatol 2016; 1: 273-282.
Pigneur B, Seksik P, Viola S et al. Natural history of Crohn's disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis 2010; 16: 953-961.
Benchimol EI, Mack DR, Nguyen GC et al. Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease. Gastroenterology 2014; 147: 803-813 e7; quiz e14-5.
Duricova D, Fumery M, Annese V, Lakatos PL, Peyrin-Biroulet L, Gower-Rousseau C. The natural history of Crohn's disease in children: a review of population-based studies. Eur J Gastroenterol Hepatol 2017; 29: 125-134.
Nguyen GC, Loftus EV Jr, Hirano I, Falck-Ytter Y, Singh S, Sultan S. American Gastroenterological Association Institute Guideline on the Management of Crohn's Disease After Surgical Resection. Gastroenterology 2017; 152: 271-275.
Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn's disease. Ann Surg 2000; 231: 38-45.
Hofer B, Bottger T, Hernandez-Richter T, Seifert JK, Junginger T. The impact of clinical types of disease manifestation on the risk of early postoperative recurrence in Crohn's disease. Hepatogastroenterology 2001; 48: 152-155.
Romberg-Camps MJ, Dagnelie PC, Kester AD et al. Influence of phenotype at diagnosis and of other potential prognostic factors on the course of inflammatory bowel disease. Am J Gastroenterol 2009; 104: 371-383.
Amil J, Kolaček S, Turner D et al. Surgical management of Crohn disease in children-guidelines from the Paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr 2017; 64: 818-835 1 p.
Lenaerts C, Roy CC, Vaillancourt M, Weber AM, Morin CL, Seidman E. High incidence of upper gastrointestinal tract involvement in children with Crohn disease. Pediatrics 1989; 83: 777-781.
Crocco S, Martelossi S, Giurici N, Villanacci V, Ventura A. Upper gastrointestinal involvement in paediatric onset Crohn's disease: prevalence and clinical implications. Journal of Crohn's and Colitis 2012; 6: 51-55.
Van Limbergen J, Russell RK, Drummond HE et al. Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 2008; 135: 1114-1122.
Witte AM, Veenendaal RA, Van Hogezand RA, Verspaget HW, Lamers CB. Crohn's disease of the upper gastrointestinal tract: the value of endoscopic examination. Scand J Gastroenterol Suppl 1998; 225: 100-105.
Splawski JB, Pffefferkorn MD, Schaefer ME et al. NASPGHAN clinical report on postoperative recurrence in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2017; 65: 475-486.
Boualit M, Salleron J, Turck D et al. Long-term outcome after first intestinal resection in pediatric-onset Crohn's disease: a population-based study. Inflamm Bowel Dis 2013; 19: 7-14.
Turner D, Levine A, Escher JC et al. Management of pediatric ulcerative colitis: joint ECCO and ESPGHAN evidence-based consensus guidelines. J Pediatr Gastroenterol Nutr 2012; 55: 340-361.
Talabur Horje CS, Meijer J, Rovers L, van Lochem EG, Groenen MJ, Wahab PJ. Prevalence of upper gastrointestinal lesions at primary diagnosis in adults with inflammatory bowel disease. Inflamm Bowel Dis 2016; 22: E33-E34.
De Cruz P, Kamm MA, Hamilton AL et al. Crohn's disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406-1417.
Dretzke J, Edlin R, Round J et al. A systematic review and economic evaluation of the use of tumour necrosis factor-alpha (TNF-alpha) inhibitors, adalimumab and infliximab, for Crohn's disease. Health Technol Assess (Winch Eng) 2011; 15: 1-244.
National Institute for Health and Care Excellence. Infliximab and adalimumab for the treatment of Crohn's disease 2010 [cited 2017 20 March]. Available from: https://www.nice.org.uk/guidance/ta187.
Yoshida K, Fukunaga K, Ikeuchi H et al. Scheduled infliximab monotherapy to prevent recurrence of Crohn's disease following ileocolic or ileal resection: a 3-year prospective randomized open trial. Inflamm Bowel Dis 2012; 18: 1617-1623.
Dulai PS, Siegel CA, Colombel JF, Sandborn WJ, Peyrin-Biroulet L. Systematic review: Monotherapy with antitumour necrosis factor alpha agents versus combination therapy with an immunosuppressive for IBD. Gut 2014; 63: 1843-1853.
Jones GR, Kennedy NA, Lees CW, Arnott ID, Satsangi J. Systematic review: the use of thiopurines or anti-TNF in post-operative Crohn's disease maintenance-progress and prospects. Aliment Pharmacol Ther 2014; 39: 1253-1265.
Levine A, Griffiths A, Markowitz J et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 2011; 17: 1314-1321.
NHS. NHS Research Ethics Committee Approval (n.a.) Available from: http://www.hra-decisiontools.org.uk/ethics/.
Baldassano RN, Han PD, Jeshion WC et al. Pediatric Crohn's disease: risk factors for postoperative recurrence. Am J Gastroenterol 2001; 96: 2169-2176.
Diederen K, de Ridder L, van Rheenen P et al. Complications and disease recurrence after primary ileocecal resection in pediatric Crohn's disease: a multicenter cohort analysis. Inflamm Bowel Dis 2017; 23: 272-282.
Gupta N, Cohen SA, Bostrom AG et al. Risk factors for initial surgery in pediatric patients with Crohn's disease. Gastroenterology; 130: 1069-1077.
Han YM, Kim JW, Koh SJ et al. Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection. J Gastroenterol Hepatol 2016; 31: 1436-1442.
Swoger JM, Regueiro M. Preventive therapy in postoperative Crohn's disease. Curr Opin Gastroenterol 2010; 26: 337-343.
De Cruz P, Kamm MA, Prideaux L, Allen PB, Desmond PV. Postoperative recurrent luminal Crohn's disease: a systematic review. Inflamm Bowel Dis 2012; 18: 758-777.
Hansen LF, Jakobsen C, Paerregaard A, Qvist N, Wewer V. Surgery and postoperative recurrence in children with Crohn disease. J Pediatr Gastroenterol Nutr 2015; 60: 347-351.
Sakuraba A, Iwao Y, Matsuoka K et al. Endoscopic and pathologic changes of the upper gastrointestinal tract in Crohn's disease. Biomed Res Int 2014; 2014: 610767.
Fazio VW, Marchetti F, Church M et al. Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial. Ann Surg 1996; 224: 563-571 discussion 71-3.