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J Crohns Colitis. 2017 Jan;11(1):77-83. doi: 10.1093/ecco-jcc/jjw134. Epub 2016 Jul 27.

Outcomes with Anti-Tumour Necrosis Factor-Alpha Therapy and Serology in Patients with Denovo Crohn's Disease After Ileal Pouch Anal Anastomosis.

Author information

1
Departments of Medicine, Colon and Rectal Surgery.
2
Gastroenterology.
3
and Pediatrics.
4
Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
5
Gastroenterology PFleshner@aol.com.

Abstract

BACKGROUND AND AIMS:

A subset of patients who undergo ileal pouch-anal anastomosis [IPAA] for ulcerative colitis [UC] will later be diagnosed with denovo Crohn's disease [CD]. These patients have a higher risk of pouch failure. In this study we evaluated inflammatory bowel disease [IBD] serology in patients with denovo CD and examined the success of anti-tumour necrosis factor-alpha [anti-TNFα] therapy in preventing ileostomy in denovo CD patients who failed anti-TNFα therapy before IPAA.

METHODS:

A prospectively maintained database of patients undergoing IPAA was reviewed to identify patients who developed denovo CD [defined as small bowel inflammation above the pouch inlet or pouch fistula/perianal disease appearing more than 3 months after stoma closure]. Clinical characteristics and IBD serology were analysed. Treatment failure was defined as pouch failure requiring ileostomy or pouchectomy.

RESULTS:

Of 350 patients included in the study, 92 [26%] patients developed denovo CD. Significantly more denovo CD patients had anti-I2 positivity postoperatively versus preoperatively [p = 0.007]. Anti-TNFα therapy successfully treated denovo CD in 28 out of 38 [74%] patients. Out of 17 patients with denovo CD who had failed to respond to anti-TNFα agents before surgery and were treated with anti-TNFα therapy after surgery, 12 [71%] patients responded to treatment.

CONCLUSIONS:

I2 serology may possibly help identify patients who have developed or are at risk for developing denovo CD. Anti-TNFα therapy for denovo CD after IPAA can help prevent permanent ileostomy in almost 75% of cases, even in patients who previously failed anti-TNFα treatment before surgery.

KEYWORDS:

Biomarkers; surgery

PMID:
27466172
DOI:
10.1093/ecco-jcc/jjw134
[Indexed for MEDLINE]

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