克罗恩病肠衰竭发展后的疾病复发和长期结局:来自国家参考中心的20多年经验

IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Crohns & Colitis Pub Date : 2023-12-30 DOI:10.1093/ecco-jcc/jjad105
Maja Kopczynska, Benjamin Crooks, Liat Deutsch, Thomas Conley, Catherine Stansfield, Ashley Bond, Mattias Soop, Gordon Carlson, Simon Lal
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引用次数: 0

摘要

背景和目的:肠衰竭(IF)是克罗恩病(CD)公认的并发症。本研究的目的是确定预测IF (CD-IF)患者CD发生和复发的因素,以及他们的长期预后。方法:这是一项队列研究,纳入了2000-2021年期间进入英国国家IF参考中心的成年CD-IF患者。患者出院后接受家庭肠外营养(HPN)随访至2021年2月28日死亡。结果:纳入124例患者;在CD和CD- if诊断之间,47例(37.9%)改变了疾病部位,55例(44.4%)改变了疾病行为,增加了上胃肠道受损伤(4.0%对22.6%)。结论:这是报道CD- if患者疾病行为和长期结果的最大系列研究,也是首次描述预防性治疗使用的研究。疾病复发率低。免疫抑制治疗在hpn依赖患者中似乎是安全的,没有增加CRBSI的风险。CD-IF的管理需要根据患者的手术病史和疾病表型进行调整。
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Disease Recurrence and Long-term Outcomes Following the Development of Intestinal Failure in Crohn's Disease: Over 20 Years of Experience from a National Reference Centre.

Background and aims: Intestinal failure [IF] is a recognised complication of Crohn's disease [CD]. The aim of this study was to identify factors predicting the development and recurrence of CD in patients with IF [CD-IF], and their long-term outcomes.

Methods: This was a cohort study of adults with CD-IF admitted to a national UK IF reference centre between 2000 and 2021. Patients were followed from discharge with home parenteral nutrition [HPN] until death or February 28, 2021.

Results: In all, 124 patients were included; 47 [37.9%] changed disease location and 55 [44.4%] changed disease behaviour between CD and CD-IF diagnosis, with increased upper gastrointestinal involvement [4.0% vs 22.6% patients], p <0.001. Following IF diagnosis, 29/124 [23.4%] patients commenced CD prophylactic medical therapy; 18 [62.1%] had a history of stricturing or penetrating small bowel disease; and nine [31.0%] had ileocolonic phenotype brought back into continuity. The cumulative incidence of disease recurrence was 2.4% at 1 year, 16.3% at 5 years and 27.2% at 10 years; colon-in-continuity and prophylactic treatment were associated with an increased likelihood of disease recurrence. Catheter-related bloodstream infection [CRBSI] rate was 0.32 episodes/1000 catheter days, with no association between medical therapy and CRBSI rate.

Conclusions: This is the largest series reporting disease behaviour and long-term outcomes in CD-IF and the first describing prophylactic therapy use. The incidence of disease recurrence was low. Immunosuppressive therapy appears to be safe in HPN-dependent patients with no increased risk of CRBSI. The management of CD-IF needs to be tailored to the patient's surgical disease history alongside disease phenotype.

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来源期刊
Journal of Crohns & Colitis
Journal of Crohns & Colitis 医学-胃肠肝病学
CiteScore
15.50
自引率
7.50%
发文量
1048
审稿时长
1 months
期刊介绍: Journal of Crohns and Colitis is concerned with the dissemination of knowledge on clinical, basic science and innovative methods related to inflammatory bowel diseases. The journal publishes original articles, review papers, editorials, leading articles, viewpoints, case reports, innovative methods and letters to the editor.
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