1
|
Bastida Paz G, Merino Ochoa O, Aguas Peris M, Barreiro-de Acosta M, Zabana Y, Ginard Vicens D, Ceballos Santos D, Muñoz Núñez F, Monfort I Miquel D, Catalán-Serra I, García Sánchez V, Loras Alastruey C, Lucendo Villarín A, Huguet JM, de la Coba Ortiz C, Aldeguer Manté X, Palau Canós A, Domènech Morral E, Nos P. The Risk of Developing Disabling Crohn's Disease: Validation of a Clinical Prediction Rule to Improve Treatment Decision Making. Dig Dis 2023; 41:879-889. [PMID: 37611561 DOI: 10.1159/000531789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Crohn's disease (CD) is characterized by the development of complications over the course of the disease. It is crucial to identify predictive factors of disabling disease, in order to target patients for early intervention. We evaluated risk factors of disabling CD and developed a prognostic model. METHODS In total, 511 CD patients were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to identify demographic, clinical, and biological risk factors. A predictive nomogram model was developed in a subgroup of patients with noncomplicated CD (inflammatory pattern and no perianal disease). RESULTS The rate of disabling CD within 5 years after diagnosis was 74.6%. Disabling disease was associated with gender, location of disease, requirement of steroids for the first flare, and perianal lesions. In the subgroup of patients (310) with noncomplicated CD, the rate of disabling CD was 80%. In the multivariate analysis age at onset <40 years (OR = 3.46, 95% confidence interval [CI] = 1.52-7.90), extensive disease (L3/L4) (OR = 2.67, 95% CI = 1.18-6.06), smoking habit (OR = 2.09, 95% CI = 1.03-4.27), requirement of steroids at the first flare (OR = 2.20, 95% CI = 1.09-4.45), and albumin (OR = 0.59, 95% CI = 0.36-0.96) were associated with development of disabling disease. The developed predictive nomogram based on these factors presented good discrimination, with an area under the receiver operating characteristic curve of 0.723 (95% CI: 0.670-0.830). CONCLUSION We identified predictive factors of disabling CD and developed an easy-to-use prognostic model that may be used in clinical practice to help identify patients at high risk and address treatment effectively.
Collapse
Affiliation(s)
- Guillermo Bastida Paz
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Olga Merino Ochoa
- Gastroenterology, Hospital Universitario de Cruces, Barakaldo, Spain
| | - Mariam Aguas Peris
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Yamile Zabana
- Gastroenterology Department, Fundació per la Recerca Mútua Terrassa, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | - Fernando Muñoz Núñez
- University Hospital of Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | | | - Ignacio Catalán-Serra
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Centre of Molecular Inflammation Research (CEMIR) and Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Carmen Loras Alastruey
- Gastroenterology Department, Fundació per la Recerca Mútua Terrassa, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | | | | | | | | | - Eugeni Domènech Morral
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Pilar Nos
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
2
|
Barreiro-De Acosta M, Domènech E, Martín Arranz MD, García Sánchez V, Gutiérrez Casbas A, Chaparro M, Alcain G, Iborra M, Taxonera C, Rodriguez-Lago I, Menchén L, Khorrami S, Romero C, Cea-Calvo L, Juliá B. Endoscopic follow-up and therapeutic attitude after ileocolonic resection in a nationwide Spanish cohort of Crohn's disease patients: the Practicrohn study. Expert Rev Gastroenterol Hepatol 2019; 13:807-813. [PMID: 31203691 DOI: 10.1080/17474124.2019.1626717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: In patients with Crohn's disease (CD), endoscopic recurrence precedes clinical recurrence after ileocolonic resection. Guidelines recommend ileocolonoscopy within the first year after surgery. The study examined endoscopic monitoring and treatment decisions in CD patients in a real-world setting. Methods: The Practicrohn study involved adult patients from 26 Spanish hospitals who underwent ileocolonic resection with anastomosis from 2007 to 2010. Medical records data were collected retrospectively from diagnosis to index surgery and up to 5 years after surgery. Results: Of 314 analyzed patients, 262 (83%) underwent endoscopic evaluation, but only 30% (n = 95) had planned endoscopy as part of follow-up within the first year after surgery. An upward trend was observed in the proportion of endoscopies performed or planned within the first year after surgery across the selection period. More patients with than without endoscopic recurrence in the first year after surgery had a medication change, mainly for endoscopic activity in the absence of clinical symptoms (54 vs 13%; p = 0.02). Conclusions: Between 2007 and 2010, endoscopic monitoring of patients within the first year after CD-related surgery was less than adequate based on current standards, but showed improvement. Medication changes were in general agreement with current guideline recommendations. This work was presented as a poster (number P686) by M. Barreiro-de Acosta et al. at ECCO (European Crohn's and Colitis Organisation) '18 in Vienna, Austria, 14-17 February 2018.
Collapse
Affiliation(s)
- Manuel Barreiro-De Acosta
- a Gastroenterology Unit, Complejo Hospitalario Universitario de Santiago , Santiago de Compostela , Spain
| | - Eugeni Domènech
- b Gastroenterology Unit, Hospital Universitari Germans Trias i Pujol , Badalona , Spain.,c CIBEREHD Instituto de Salud Carlos III , Madrid , Spain
| | | | | | - Ana Gutiérrez Casbas
- c CIBEREHD Instituto de Salud Carlos III , Madrid , Spain.,f Digestive Medicine Department, Hospital General de Alicante , Spain
| | - María Chaparro
- c CIBEREHD Instituto de Salud Carlos III , Madrid , Spain.,g Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) , Madrid , Spain
| | - Guillermo Alcain
- h Gastroenterology Unit, Hospital Virgen de la Victoria , Málaga , Spain
| | - Marisa Iborra
- c CIBEREHD Instituto de Salud Carlos III , Madrid , Spain.,i Gastroenterology Unit, Hospital La Fe , Valencia , Spain
| | - Carlos Taxonera
- j Gastroenterology Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) , Madrid , Spain
| | - Iago Rodriguez-Lago
- k Hospital de Galdakao, Galdakao Biocruces Bizkaia Health Research Institute , Barakaldo , Spain
| | - Luis Menchén
- c CIBEREHD Instituto de Salud Carlos III , Madrid , Spain.,l Gastroenterology Unit, Hospital General Universitario Gregorio Marañón , Madrid , Spain.,m Medicine Department, Universidad Complutense de Madrid , Spain
| | - Sam Khorrami
- n Gastroenterology Unit, Hospital Son Espases , Palma de Mallorca , Spain
| | - Cristina Romero
- o Medical Department, Merck Sharp & Dohme of Spain , Madrid , Spain
| | - Luis Cea-Calvo
- o Medical Department, Merck Sharp & Dohme of Spain , Madrid , Spain
| | - Berta Juliá
- o Medical Department, Merck Sharp & Dohme of Spain , Madrid , Spain
| |
Collapse
|
3
|
Gutiérrez A, Rivero M, Martín-Arranz MD, García Sánchez V, Castro M, Barrio J, de Francisco R, Barreiro-de Acosta M, Juliá B, Cea-Calvo L, Romero C, Borruel Sainz N, Domènech E. Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn's disease: analysis from the PRACTICROHN study. Gastroenterol Rep (Oxf) 2019; 7:168-175. [PMID: 31217980 PMCID: PMC6573802 DOI: 10.1093/gastro/goz010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/07/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background This study is aimed at describing the prevalence of and risk factors associated with early post-operative complications after Crohn's disease-related intestinal resection. Methods This was a retrospective analysis of data from the PRACTICROHN cohort. Adult Crohn's disease patients who underwent ileocolonic resection with ileocolonic anastomosis between January 2007 and December 2010 were included. The complications evaluated included death, ileus, anastomotic leak, abscess, wound infection, catheter-related infection, digestive bleeding and other extra-abdominal infections that occurred in the 30 days after surgery. Results A total of 364 patients (median age at surgery 38 years and 50% men) were included. Indication for surgery was: stricturing disease (46.4%), penetrating disease (31.3%), penetrating and stricturing disease (14.0%) or resistance to medical treatment (5.8%). Early complications were recorded in 100 (27.5%) patients, with wound infection, intra-abdominal abscess and anastomotic leakage being the most frequent complications. Median hospitalization duration was 16 days for patients with complications vs. 9 days without complications (P < 0.001). Complications were more common among patients with penetrating disease (36/114, 31.6%) and those refractory to treatment (9/21, 42.9%) compared with stricturing disease (45/169, 26.6%) or stricturing + penetrating disease (6/51, 11.8%) (P = 0.040). The rate of complications was higher among patients with diagnosis made at the time of surgery (15/31, 48.4%) compared with the rest (85/331, 25.7%) (P = 0.013). Medication received at the time of surgery did not affect the rate of complications. Conclusions Almost a quarter of patients developed early complications after intestinal resection. Penetrating disease and urgent surgery were associated with an increased risk of complications.
Collapse
Affiliation(s)
- Ana Gutiérrez
- Gastroenterology Department, General University Hospital of Alicante and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III Health Institute, Madrid, Spain
| | - Montserrat Rivero
- Gastroenterology Department, Marques de Valdecilla General University Hospital, Santander, Spain
| | - Maria Dolores Martín-Arranz
- Gastroenterology Department, La Paz General University Hospital, Instituto de Investigación Biomédica La Paz (IdiPaz), Madrid, Spain
| | - Valle García Sánchez
- Clinical Management of Gastrointestinal Tract Diseases Unit, Reina Sofia University Hospital, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba University, Cordoba, Spain
| | - Manuel Castro
- Gastroenterology Department, Valme University Hospital, Sevilla, Spain
| | - Jesús Barrio
- Gastroenterology Department, University Hospital, Río Hortega, Valladolid, Spain
| | - Ruth de Francisco
- Gastroenterology Department, University Hospital Central de Asturias, Oviedo, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Inflammatory Bowel Disease Unit, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Berta Juliá
- Medical Department, Merck Sharp and Dohme, Madrid, Spain
| | - Luis Cea-Calvo
- Medical Department, Merck Sharp and Dohme, Madrid, Spain
| | | | - Natalia Borruel Sainz
- Crohn-Colitis Care Unit (UACC), Digestive Tract Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Germans Trias i Pujol University Hospital and CIBERehd, Badalona, Spain
| |
Collapse
|
4
|
Marín-Jiménez I, García Sánchez V, Gisbert JP, Lázaro Pérez Calle J, Luján M, Gordillo Ábalos J, Tabernero S, Juliá B, Romero C, Cea-Calvo L, García-Vicuña R, Vanaclocha F. [Immune-mediated inflammatory diseases in patients with inflammatory bowel disease. Baseline data from the Aquiles study]. Gastroenterol Hepatol 2014; 37:495-502. [PMID: 24717523 DOI: 10.1016/j.gastrohep.2014.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/03/2014] [Accepted: 02/25/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the prevalence of immune-mediated inflammatory diseases (IMID) in a cohort of patients with inflammatory bowel disease (IBD) enrolled in hospital gastroenterology outpatients units for the AQUILES study, a prospective 2-year follow-up study. MATERIAL AND METHODS We included patients ≥18 years old with a prior or new diagnosis of IBD (Crohn disease [CD], ulcerative colitis [UC] or indeterminate colitis). Diagnoses were collected in a cross-sectional manner from the clinical records at enrollment of a new patient in the study. RESULTS We included 526 patients (mean age 40.2 years; 47.3% men, 52.7% women), 300 with CD (57.0%), 218 with UC (41.4%) and 8 with indeterminate colitis. Other types of IMID were present in 71 patients (prevalence: 13.5%, 95% CI: 10.8-16.7): 47 were spondyloarthropathies (prevalence: 8.9%); 18 psoriasis (3.4%); 5 pyoderma gangrenosum (1.0%), and 11 uveitis (2.1%). The prevalence of IMID was higher in patients with CD than in those with UC (17.0% [95% CI: 13.2-21.7] vs 9.2% [95% CI: 6.0-13.8], p=0.011). In the multivariate analysis, the variables associated with the presence of IMID were diagnosis of CD (OR=1.8 [95% CI: 1.1-3.2]) and duration of IBD ≥4 years (OR=2.1 [95% CI: 1.1-4.1] in those with disease duration 4-8 years, and OR=2.1 [95% CI: 1.2-3.9] in those with ≥8 years vs. <4 years). CONCLUSIONS In the cohort of patients with IBD in the AQUILES study, 13.5% had another IMID, with a higher prevalence in patients with CD and>4 years since disease onset.
Collapse
Affiliation(s)
| | | | - Javier P Gisbert
- Servicio de Gastroenterología, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria Princesa (IISP), Madrid,/Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), España
| | | | - Marisol Luján
- Servicio de Gastroenterología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | | | - Susana Tabernero
- Servicio de Gastroenterología, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Berta Juliá
- Departamento Médico, Merck, Sharp & Dohme de España, España
| | | | - Luis Cea-Calvo
- Departamento Médico, Merck, Sharp & Dohme de España, España
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital La Princesa, IISP/Instituto de Investigación Sanitaria Princesa (IISP), Madrid, España
| | | |
Collapse
|
5
|
Benítez Cantero JM, Jurado García J, Ruiz Cuesta P, González Galilea A, Muñoz García-Borruel M, García Sánchez V, Gálvez Calderón C. [Early evaluation of anaemia in patients with acute gastrointestinal bleeding: venous blood gas analysis compared to conventional laboratory]. Med Clin (Barc) 2013; 141:332-7. [PMID: 23103108 DOI: 10.1016/j.medcli.2012.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/10/2012] [Accepted: 07/12/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB). PATIENTS AND METHODS Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis. RESULTS One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB. CONCLUSIONS Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results.
Collapse
|
6
|
Jurado García J, Ruiz Cuesta P, Hervás Molina AJ, Rodríguez Perálvarez ML, García Sánchez V. [Endoscopic extraction of a foreign body in the sigmoid colon]. Gastroenterol Hepatol 2013; 36:647-8. [PMID: 23856088 DOI: 10.1016/j.gastrohep.2013.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Juan Jurado García
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España.
| | | | | | | | | |
Collapse
|
7
|
Cerezo Ruiz A, Gómez Camacho F, García Sánchez V, Iglesias Flores E, Gallardo Valverde JM, DE Dios Vega JF. [A young woman with Crohn's disease and portal gas]. Gastroenterol Hepatol 2009; 31:550-1. [PMID: 18928763 DOI: 10.1157/13127106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
8
|
Luis Cabriada J, García Sánchez V, Gomollón F, Hinojosa J, San Román AL, Luis Mendoza J, Mínguez M, Ricart E, Saro C. Recomendaciones de actuación en pacientes con enfermedad de Crohn que empiezan tratamiento con adalimumab: una guía rápida. Gastroenterología y Hepatología 2008; 31:693-7. [DOI: 10.1016/s0210-5705(08)75817-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 05/28/2008] [Indexed: 01/06/2023]
|
9
|
García Sánchez V, Iglesias Flores E, Gómez Camacho F. [What determines corticosteroid choice in a specific patient?]. Gastroenterol Hepatol 2008; 31 Suppl 3:27-37. [PMID: 19087861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Valle García Sánchez
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España.
| | | | | |
Collapse
|