Mistakes in the management of postoperative Crohn’s disease and how to avoid them

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Mistakes in the management of postoperative Crohn’s disease and how to avoid them

Miriam Mañosa Ciria, Eugeni Domenech Morral

Summary

AI Generated

This material addresses common management errors to avoid in postoperative Crohn's disease patients, focusing on the prevention and recognition of postoperative recurrence following intestinal resection.

Up to 70% of Crohn's disease patients develop new mucosal lesions in the neoterminal ileum within the first year after intestinal resection if no preventive therapy is started early after surgery.
Postoperative recurrence occurs in three forms: endoscopic (mucosal lesions on ileocolonoscopy), clinical (symptomatic), and surgical (requiring repeat resection), with endoscopic recurrence preceding clinical symptoms.
Ileocecal resection plus ileocolic anastomosis is the most common surgical procedure for managing Crohn's disease complications including strictures, fistulae, inflammatory masses and abscesses.
The material provides guidance based on available evidence and clinical experience for gastroenterologists managing postoperative Crohn's disease patients.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Bossuyt P, et al. The operative risk and natural history after the diagnosis of ileal penetrating Crohn's disease. Eur J Gastroenterol Hepatol 2018; 30: 539–545. [Link]

Domènech E, Mañosa M and Cabré E. An overview of the natural history of inflammatory bowel disease. Dig Dis 2014; 32: 320–327. [Link]

Rutgeerts P, et al. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990; 99: 956–963. [Link]

Reese GE, et al. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis 2008; 23: 1213–1221. [Link]

De Cruz P, et al. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflamm Bowel Dis 2012; 18: 758–777. [Link]

Domènech E, et al. Recommendations of the Spanish Working Group on Crohn’s disease and ulcerative colitis (GETECCU) on the monitoring, prevention and treatment of postoperative recurrence in Crohn’s disease. Gastroenterol Hepatol 2017; 40: 472–483. [Link]

Nguyen GC, et al. American Gastroenterological Association Institute guideline on the management of Crohn’s disease after surgical resection. Gastroenterology 2017; 152: 271–275. [Link]

Boschetti G, et al. Levels of fecal calprotectin are associated with the severity of postoperative endoscopic recurrence in asymptomatic patients with Crohn's disease. Am J Gastroenterol 2015; 110: 865–872. [Link]

Wright EK, et al. Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery. Gastroenterology 2015; 148: 938–947. [Link]

10.

Garcia-Planella E, et al. Fecal calprotectin levels are closely correlated with the absence of relevant mucosal lesions in postoperative Crohn’s disease. Inflamm Bowel Dis 2016; 22: 2879–2885. [Link]

11.

Lamb CA, et al. Faecal calprotectin or lactoferrin can identify postoperative recurrence in Crohn's disease. Br J Surg 2009; 96: 663–674. [Link]

12.

D'Amico F, et al. International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases. United European Gastroenterol J 2021; 9: 451–460. [Link]

13.

Mañosa M, et al. Addition of metronidazole to azathioprine for the prevention of postoperative recurrence of Crohn’s disease: a randomized, double-blind, placebo-controlled trial. Inflamm Bowel Dis 2013; 19: 1889–1895. [Link]

14.

Ferrante M, et al. Systematic versus endoscopy-driven treatment with azathioprine to prevent postoperative ileal Crohn's disease recurrence. J Crohns Colitis 2015; 9: 617–624. [Link]

15.

Cañete F, et al. Antitumor necrosis factor agents to treat endoscopic postoperative recurrence of Crohn's disease: A nationwide study with propensity-matched score analysis. Clin Transl Gastroenterol 2020; 11: e00218. [Link]

16.

Pouillon L, et al. Risk of late postoperative recurrence of Crohn's disease in patients in endoscopic remission after ileocecal resection, over 10 years at multiple centers. Clin Gastroenterol Hepatol 2021; 19: 1218–1225. [Link]

17.

De Cruz P, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406–1417. [Link]

18.

Rivière P, et al. Rates of postoperative recurrence of Crohn's disease and effects of immunosuppressive and biologic therapies. Clin Gastroenterol Hepatol 2021; 19: 713–720. [Link]

19.

Lémann M, et al. A randomized, double-blind, controlled withdrawal trial in Crohn's disease patients in long-term remission on azathioprine. Gastroenterology 2005; 128: 1812–1818. [Link]

20.

Fumery M, et al. Systematic review with meta-analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy. Aliment Pharmacol Ther 2017; 45: 381–390. [Link]

21.

Ghishan FK and Kiela PR. Vitamins and minerals in inflammatory bowel disease. Gastroenterol Clin North Am 2017; 46: 797–808. [Link]

22.

Dignass AU, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis 2015; 9 : 211–222. [Link]

Abstract

Crohn’s disease is a chronic immune-mediated inflammatory condition that usually produces cumulative transmural intestinal damage. Disease-related complications, such as intestinal strictures and intra-abdominal penetrating complications (including enteric fistulae, inflammatory masses and abscesses), are mostly managed via a surgical approach, with ileocecal resection plus ileocolic anastomosis being the most common procedure. Despite the curative intention of surgery, however, up to 70% of patients develop new mucosal lesions in the neoterminal ileum within the first year of intestinal resection if no preventive therapy is started early after surgery. This postoperative recurrence (POR) can be described as endoscopic, clinical or surgical. Endoscopic POR—defined as the presence of mucosal lesions in the neoterminal ileum, as assessed by ileocolonoscopy—precedes the development of symptoms (clinical POR), which may lead to the need for new surgical resections (surgical POR). Here we discuss the errors to avoid when managing patients with Crohn’s disease in the postoperative setting. The discussion is based on evidence, whenever possible, as well as on our clinical experience and perception of the field.

Topics

IBD

Citation

Domènech E and Mañosa M. Mistakes in the management of postoperative Crohn’s disease and how to avoid them. UEG Education 2022; 22: 5–7.

Published

2022

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Affiliations

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2 Hospital General Universitario de Alicante, Alicante, Spain

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Bossuyt P, et al. The operative risk and natural history after the diagnosis of ileal penetrating Crohn's disease. Eur J Gastroenterol Hepatol 2018; 30: 539–545. [Link]

Domènech E, Mañosa M and Cabré E. An overview of the natural history of inflammatory bowel disease. Dig Dis 2014; 32: 320–327. [Link]

Rutgeerts P, et al. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990; 99: 956–963. [Link]

Reese GE, et al. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis 2008; 23: 1213–1221. [Link]

De Cruz P, et al. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflamm Bowel Dis 2012; 18: 758–777. [Link]

Nguyen GC, et al. American Gastroenterological Association Institute guideline on the management of Crohn’s disease after surgical resection. Gastroenterology 2017; 152: 271–275. [Link]

Wright EK, et al. Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery. Gastroenterology 2015; 148: 938–947. [Link]

10.

11.

Lamb CA, et al. Faecal calprotectin or lactoferrin can identify postoperative recurrence in Crohn's disease. Br J Surg 2009; 96: 663–674. [Link]

12.

13.

14.

Ferrante M, et al. Systematic versus endoscopy-driven treatment with azathioprine to prevent postoperative ileal Crohn's disease recurrence. J Crohns Colitis 2015; 9: 617–624. [Link]

15.

16.

17.

De Cruz P, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406–1417. [Link]

18.

Rivière P, et al. Rates of postoperative recurrence of Crohn's disease and effects of immunosuppressive and biologic therapies. Clin Gastroenterol Hepatol 2021; 19: 713–720. [Link]

19.

Lémann M, et al. A randomized, double-blind, controlled withdrawal trial in Crohn's disease patients in long-term remission on azathioprine. Gastroenterology 2005; 128: 1812–1818. [Link]

20.

Fumery M, et al. Systematic review with meta-analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy. Aliment Pharmacol Ther 2017; 45: 381–390. [Link]

21.

Ghishan FK and Kiela PR. Vitamins and minerals in inflammatory bowel disease. Gastroenterol Clin North Am 2017; 46: 797–808. [Link]

22.

Dignass AU, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis 2015; 9 : 211–222. [Link]

Abstract

Alteration of common coagulation tests and thrombocytopenia represent an integral part of the clinical picture of patients with advanced chronic liver disease. As such, the International Normalised Ratio (INR) for prothrombin time is part of the Model for End-stage Liver Disease (MELD) score, which is commonly used to assess prognosis and the need for liver transplantation in patients with cirrhosis. Thrombocytopenia—being mainly related to hypersplenism and decreased synthesis of thrombopoietin by the liver—can also be used to identify the presence of portal hypertension and decreased liver function in patients with chronic liver disease.

Topics

Hepatobiliary

Citation

Giannini EG and Caldwell SH. Mistakes in coagulation in liver disease and how to avoid them. UEG Education 2021; 21: 29–34.

Published

2021

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Bossuyt P, et al. The operative risk and natural history after the diagnosis of ileal penetrating Crohn's disease. Eur J Gastroenterol Hepatol 2018; 30: 539–545. [Link]

Domènech E, Mañosa M and Cabré E. An overview of the natural history of inflammatory bowel disease. Dig Dis 2014; 32: 320–327. [Link]

Rutgeerts P, et al. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990; 99: 956–963. [Link]

Reese GE, et al. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis 2008; 23: 1213–1221. [Link]

De Cruz P, et al. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflamm Bowel Dis 2012; 18: 758–777. [Link]

Nguyen GC, et al. American Gastroenterological Association Institute guideline on the management of Crohn’s disease after surgical resection. Gastroenterology 2017; 152: 271–275. [Link]

Wright EK, et al. Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn's disease after surgery. Gastroenterology 2015; 148: 938–947. [Link]

10.

11.

Lamb CA, et al. Faecal calprotectin or lactoferrin can identify postoperative recurrence in Crohn's disease. Br J Surg 2009; 96: 663–674. [Link]

12.

13.

14.

Ferrante M, et al. Systematic versus endoscopy-driven treatment with azathioprine to prevent postoperative ileal Crohn's disease recurrence. J Crohns Colitis 2015; 9: 617–624. [Link]

15.

16.

17.

De Cruz P, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet 2015; 385: 1406–1417. [Link]

18.

Rivière P, et al. Rates of postoperative recurrence of Crohn's disease and effects of immunosuppressive and biologic therapies. Clin Gastroenterol Hepatol 2021; 19: 713–720. [Link]

19.

Lémann M, et al. A randomized, double-blind, controlled withdrawal trial in Crohn's disease patients in long-term remission on azathioprine. Gastroenterology 2005; 128: 1812–1818. [Link]

20.

Fumery M, et al. Systematic review with meta-analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy. Aliment Pharmacol Ther 2017; 45: 381–390. [Link]

21.

Ghishan FK and Kiela PR. Vitamins and minerals in inflammatory bowel disease. Gastroenterol Clin North Am 2017; 46: 797–808. [Link]

22.

Dignass AU, et al. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis 2015; 9 : 211–222. [Link]

Abstract

Incidental liver lesions are increasingly found due to the incremental use of cross-sectional imaging. They encompass a large group of benign and malignant lesions, and the combined use of different imaging modalities is often required to make an accurate diagnosis. It is of utmost importance for clinicians and radiologists to be familiar with each imaging modality's strengths and limitations and be aware of common pitfalls that can confound the correct interpretation of findings. The article will discuss eight common mistakes in the interpretation and acquisition of radiological images. Recommendations on avoiding these mistakes will be based on clinical experience and literature where possible. As MRI plays an essential role in the characterisation of liver lesions, a standard MRI protocol with a brief explanation of the sequences has been added for reference

Topics

Hepatobiliary Radiology & Imaging

Citation

DePaepe K. Mistakes in imaging hepatic lesions and how to avoid them. UEG Education 2022; 22: 37-42.

Published

2022

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