International Journal of Colorectal Disease最新文献

Purpose: Several laboratory tests are used to monitor disease activity and possible complications in patients with inflammatory bowel disease (IBD). Due to limited resources, it is important to identify patients who benefit the most from tight laboratory testing and follow-up. We sought to assess the correlation between a symptom-based clinical activity index and commonly monitored laboratory tests in a large patient population.

Methods: The Finnish IBD registry records a validated IBD symptom index questionnaire (IBD-SI) that measures disease activity and the influence of IBD on daily life in patients with ulcerative colitis (UC) and Crohn's disease (CD). The activity index was compared with the commonly measured laboratory values of fecal calprotectin (FC), hemoglobin (Hb), ferritin, and C-reactive protein (CRP).

Results: A total of 5044 IBD patients with 171,967 activity index measurement pairs were included. FC, Hb, and CRP correlated significantly with the activity index in both UC (Spearman's r 0.383, -0.212, 0.175; p < 0.001) and CD (Spearman's r 0.156, -0.176, 0.152; p < 0.001). No correlation between the activity index and ferritin (Spearman's r 0.038 [UC], 0.005 [CD]; p = 0.020, p = 0.825) was found.

Conclusion: The activity index is a useful tool in the assessment of IBD activity. Active or inactive disease can be identified better, which may be beneficial in planning more personalized follow-up strategies. Tight monitoring of disease can be better targeted to the correct patient population, and the onset of disease flare may be caught at an earlier stage.

Background: The global burden of colorectal cancer (CRC) attributable to metabolic risk factors is increasing. It is crucial to analyze the global epidemiological patterns of CRC attributable to metabolic risk factors and predict future trends.

Methods: Detailed data on CRC mortality and disability-adjusted life years (DALYs) attributable to metabolic risk factors were extracted for this study using data from the Global Burden of Diseases (GBD) 2021 study to assess the burden of CRC from 1990 to 2021 by global, regional, national, and sociodemographic index (SDI) regions and quantify the time trend using the estimated annual percentage change (EAPC). Bayesian age-period-cohort (BAPC) models projected the global mortality from 2022 to 2035.

Results: The global number of CRC deaths due to metabolic risk factors increased from 70,916 in 1990 to 172,993 in 2021, a 2.4-fold increase. CRC mortality and DALYs attributable to high body mass index (BMI) and fasting plasma glucose (FPG) increased significantly at the global level from 1990 to 2021. In 2021, the GBD regions with the highest CRC age-standardized mortality rate (ASMR) due to high BMI and high FPG were in Central Europe. The ASMR of CRC attributable to high BMI and high FPG among males is expected to increase from 2022 to 2035.

Conclusion: CRC mortality and DALYs attributable to metabolic factors are increasing. Reducing the burden of CRC due to high BMI and FPG levels is critically needed.

Purpose: Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure.

Methods: Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications.

Results: A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications.

Conclusion: This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care.

Objectives: This study investigates the alarming epidemiological trends of inflammatory bowel disease (IBD) among children and young adults, highlighting the associated disease burden on global health.

Materials and methods: Utilizing data from the Global Burden of Disease (GBD) study 2021, we conducted a comprehensive analysis of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPC). Future trends were forecasted using the Bayesian age-period-cohort model.

Results: From 1990 to 2021, IBD incidence and DALY rates remained persistently high, with a concerning upward trend noted among children and young adults. While men experienced a decline in DALY rates, women faced increasing burdens. In 2021, high-income regions, particularly North America, reported the highest incidence and DALY rates, contrasting sharply with Central Latin America, which exhibited the lowest ASIR. Southeast Asia presented the most favorable DALY rates. A notable negative correlation was identified between DALY rates and socio-demographic index (SDI) at the national level, with high and high-middle SDI countries continuing to bear a substantial burden, while low and middle SDI nations faced rising challenges.

Conclusions: The persistent high burden of IBD in children and young adults signifies a critical public health concern. The marked geographical and gender disparities underscore the urgent need for tailored regional and population-based strategies aimed at primary prevention and effective management. This study illuminates the pressing necessity for policy interventions to address the growing epidemic of IBD among vulnerable populations.

Purpose: To evaluate the predictive value of MRI-determined variables for pathological complete response (pCR) in locally advanced rectal cancer (LARC) patients following neoadjuvant chemoradiotherapy (NCRT).

Methods: Clinical data were collected from patients who received NCRT between January 2019 and 2022. Patients with rectal adenocarcinoma, cT3-4N0, or TanyN1-2 were included. pCR was defined pT0N0. Patients were divided into pCR and non-pCR group. Logistic regression analysis was performed to identify factors associated with pCR. A nomogram model was constructed to validate its predictive ability and accuracy.

Results: A total of 585 patients were identified, with 144 (24.6%) in the pCR group and 441 (75.4%) in the non-pCR group. Patients with mrT2-3 (OR 6.41, P < 0.001), mrN0 (OR 2.17, P < 0.001), circumferential occupation range < 1/2 cycles (OR 2.11, P < 0.001), tumor vertical diameter < 36 mm (OR 2.10, P < 0.001), negative mesorectal fascia (OR 3.21, P < 0.001), and extramural vascular invasion (OR 5.68, P < 0.001) were more likely to achieve higher pCR rates. Logistic regression analysis revealed that mrT2-3 (OR 3.50, P < 0.001), tumor vertical diameter < 36 mm (OR 2.57, P < 0.001), and negative extramural vascular invasion (OR 4.03, P < 0.001) were independent protective factors for pCR. A nomogram was developed to predict pCR, achieving a C-index of 0.778.

Conclusion: Patients with mrT2-3, tumor vertical diameter < 36 mm, and negative extramural vascular invasion are more likely to achieve pCR after NCRT.

Introduction: Inflammatory bowel disease (IBD) has historically been seen as predominantly affecting non-Hispanic Whites (NHW). Hispanics are the largest minority group in the USA, yet they remain grossly underrepresented in studies of IBD. With this study, we aimed to better understand the epidemiology of hospitalized Hispanic patients with IBD in the US.

Methods: This was a retrospective cohort study utilizing the National Inpatient Sample, the largest publicly available all-payer inpatient care database in the United States. We compared demographics, hospitalization characteristics, clinical outcomes, and year-to-year trends from 2016 to 2020 in Hispanic and NHW with a primary diagnosis of inflammatory bowel disease, Crohn's disease, or ulcerative colitis.

Results: NHWs hospitalized with a primary diagnosis of IBD had significantly higher rates of hospitalization than Hispanics (122.67 vs 71.12, P < 0.01). While hospitalized Hispanics with IBD are more likely to be in the lowest quartile for household income (31.6% vs 19.3%, P < 0.01), have a younger median age (37.0 vs 45.0, P < 0.01), and be uninsured (4.3% vs 8.8%, P < 0.01) compared to NHW. Length of admission was similar, yet NHWs had higher rates of mortality (0.3% vs 0.2%, P = 0.01), while total charges for hospitalizations were significantly higher for Hispanic patients (P < 0.01).

Discussion: To our knowledge, this is one of the largest US-based studies of Hispanics with IBD. Our findings suggest that among hospitalized IBD patients, Hispanics are more likely to be younger, uninsured, have a lower household income, and are less likely to undergo surgery while having higher hospital charges.

Purpose: The diagnosis and treatment of puborectalis syndrome (PRS) and spastic pelvic floor syndrome (SPFS) are still up for debate. This study aims to investigate and examine the similarities and differences between PRS and SPFS.

Methods: This study recruited 13 PRS cases, 10 SPFS cases, and 16 controls. Pelvic magnetic resonance imaging (MRI), histology, and ultrastructural pathology were explored. Additionally, anorectal manometry was performed prior to surgery, and Wexner constipation scores and patient assessment of constipation quality of life (PAC-QOL) scores monitored before surgery and 6 and 12 months post-surgery.

Results: The puborectalis thickness in the pelvic MRIs of the SPFS and control groups did not appear to differ (4.62 ± 0.38 vs 4.56 ± 0.47, p = 0.378); however, the puborectalis in the PRS group was substantially thicker than that of the SPFS (8.65 ± 1.17 vs 4.62 ± 0.38, p < 0.001). The SPFS group showing atrophy and degeneration of muscle fibers and the PRS group exhibiting necrosis of muscle fibers, both groups had distorted texture myofibrils, disorganized arrangement, and rough Z lines; however, in severe cases of PRS group, localized myofibrils fracture and myofilament dissolution presenting as vacuolation. Patients with normal preoperative rectal propulsion force had improvements in postoperative Wexner constipation scores and PAC-QOL scores.

Conclusion: Histological and ultrastructural pathological evidence suggests that SPFS and PRS are distinct phases of paradoxical puborectalis syndrome (PPS). Furthermore, one indication for PPS surgical treatment is normal rectal evacuation pressure.

Purpose: Small intestine-rectal fistulas are a rare and complex complication in Crohn's disease, posing significant diagnostic and management challenges. This study aims to investigate their distinctive features and evaluates surgical outcomes.

Methods: We conducted a retrospective analysis of Crohn's disease patients with small intestine-rectal fistulas who underwent surgery from January 2019 to March 2023. Data on disease characteristics, postoperative quality of life, and functional outcomes were collected.

Results: A total of 92 patients were included, predominantly male (75%). The average time from Crohn's disease diagnosis to small intestine-rectal fistula diagnosis was 5.18 years. Most fistulas originated in the ileum (84.79%), followed by the rectum (9.78%) and both sites (5.43%). Nearly half had perianal lesions (48.91%), with some also having entero-vesical fistulas (22.83%) and entero-vaginal fistulas (1.09%). Significant risk factors for the creation of temporary protective ileostomy included preoperative hemoglobin levels below 100 g/L, albumin levels below 35 g/L, and the presence of perianal disease. Fistulas originating from the rectum and rectal lesions of 3 cm or longer were significant risk factors for rectal resection. No small intestine-rectal fistula recurrence was observed over an average follow-up of 2.35 years. Patients without a permanent sigmoidostomy after small intestine-rectal fistula resection had better stool scores and improved quality of life, especially in emotional and social functioning.

Conclusions: Small intestine-rectal fistulas in Crohn's disease have distinct characteristics. Surgical repair and resection effectively restore intestinal continuity and improve quality of life, particularly when anal function is preserved.

Purpose: The use of intrathecal morphine in open colorectal surgery has been limited despite being a promising analgesic alternative used in other types of open abdominal surgery. Intrathecal morphine has a higher success rate than thoracic epidural analgesia, the current standard method of analgesia in open colorectal surgery. Intrathecal morphine is occasionally used in open colorectal surgery when thoracic epidural analgesia placement fails and in instances when patients receive intrathecal morphine for a planned laparoscopic surgical procedure which is converted to laparotomy intraoperatively. This retrospective single-centre cohort study aimed to evaluate outcomes after intrathecal morphine in patients undergoing open colorectal surgery.

Methods: All patients who received intrathecal morphine before open colorectal surgery at a secondary hospital in Sweden between 2016 and 2020 were included. Routinely collected data from the Swedish PeriOperative Registry and patients' medical records were reviewed, and data regarding postoperative outcomes including the incidence of postoperative rescue thoracic epidural analgesia and adverse events were extracted.

Results: In total, 108 patients were included with a median age of 74 years. Four patients (4%) received rescue thoracic epidural analgesia postoperatively, and the median hospital length of stay was 8 days. The median intrathecal morphine dose was 200 µg. Respiratory complications occurred in two patients (2%).

Conclusion: The incidence of rescue thoracic epidural analgesia after intrathecal morphine in open colorectal surgery was low, and there were few adverse events. The results suggest that intrathecal morphine could be a viable alternative for postoperative pain management in open colorectal surgery.