scholarly journals Patients’ Educational Program Could Improve Azathioprine Adherence in Crohn’s Disease Maintenance Therapy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Lei Wang ◽  
Rong Fan ◽  
Chen Zhang ◽  
Liwen Hong ◽  
Tianyu Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Maintenance Therapy ◽  
Educational Program ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Educational Group ◽  
One Year ◽  
Relapse Rates

Aim. To determine the risk factors of nonadherence to azathioprine (AZA) maintenance therapy for Crohn’s disease (CD) and to evaluate the influence of patients’ educational program on adherence to AZA maintenance therapy. Methods. Patients receiving AZA as maintenance therapy for CD were enrolled. Demographic data, clinical data, and usage information were collected. Univariate and multivariate analyses were performed to identify the risk factors of nonadherence. Then, patients’ educational program was conducted. One year after the program, the improvements in adherence and relapse rates were compared between educational and noneducational groups. Results. A total of 378 CD patients receiving AZA as maintenance therapy were enrolled from September 2008 to September 2018. Nonadherence occurred in 43.9% (166/378) of patients. Univariate analysis revealed that young age, education, alcoholism, anxiety, depression, concern belief, and lack of necessity belief and AZA knowledge were risk factors of nonadherence (P<0.05). Multivariate logistic regression showed that anxiety (OR 6.244, 95% CI 2.563–15.213), depression (OR 3.801, 95% CI 1.281–11.278), and concern belief (OR 19.531, 95% CI 3.393–120.732) were independent risk factors of nonadherence. Necessity belief (OR 0.961, 95% CI 0.925–0.999) and AZA knowledge (OR 0.823, 95% CI 0.758–0.903) were protective factors of adherence. One year after the AZA educational program, the necessity belief, AZA knowledge, and adherence of the educational group significantly improved (P<0.05). Concern belief was significantly lower in the educational group than that in the noneducational group (P<0.05). Moreover, the noneducational group suffered significantly higher endoscopic relapse rates than that the educational group (15.9% vs. 30.1%, P=0.035). Conclusions. Nonadherence occurred frequently in CD patients receiving AZA maintenance therapy. Educational programs could improve patients’ adherence mainly by promoting their beliefs and knowledge of AZA and could reduce relapse rates during treatment.

scholarly journals P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S579-S580
Author(s):  
A Frontali ◽  
M Rottoli ◽  
A Chierici ◽  
G Poggioli ◽  
Y Panis
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Antibiotic Prophylaxis ◽  
Success Rate ◽  
Rectovaginal Fistula ◽  
Univariate Analysis ◽  
Diverting Stoma ◽  
Prospective Database

Abstract Background Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients. Methods We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy). Results Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196). Conclusion Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.

scholarly journals Pathophysiology and Risk Factors for Cholelithiasis in Patients with Crohn’s Disease

2019 ◽  
pp. S173-S182
Author(s):  
I. STURDIK ◽  
A. KRAJCOVICOVA ◽  
Y. JALALI ◽  
M. ADAMCOVA ◽  
M. TKACIK ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Parenteral Nutrition ◽  
Univariate Analysis ◽  
Abdominal Ultrasound ◽  
Control Group ◽  
Healthy Population ◽  
Retrospective Case ◽  
Independent Risk Factors

Cholelithiasis is more common in patients with Crohn’s disease (CD) than in the healthy population. The aim here was to examine risk factors for cholelithiasis in a cohort of CD patients and to compare the prevalence of cholelithiasis in a cohort of CD patients with that in a control group. This was a single-center retrospective case-control study. The cohort comprised all consecutive CD patients who underwent abdominal ultrasound from January 2007 to January 2018. The control group comprised age- and gender-matched non-CD patients referred for upper gastrointestinal tract dyspepsia. The study included 238 CD patients and 238 controls. The prevalence of cholelithiasis in the CD and control groups was 12.6 % and 9.2 %, respectively (risk ratio (RR), 1.36; p=0.24). Univariate analysis revealed that cholelithiasis was associated with multiple risk factors. Multivariate analysis identified age (OR, 1.077; 95 % CI, 1.043–1.112; p<0.001) and receipt of parenteral nutrition (OR, 1.812; 95 % CI, 1.131–2.903; p=0.013) as independent risk factors for cholelithiasis in CD patients. The prevalence of cholelithiasis in CD patients was higher than that in the control group; however, the difference was not statistically significant. Age and receipt of parenteral nutrition were independent risk factors for cholelithiasis in CD patients.

scholarly journals DOP62 Morbidity after primary ileocecal resection for Crohn’s disease in the years of biologics: Lesson learned over 631 patients exclusively treated in a tertiary centre

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S101-S102
Author(s):  
M Rottoli ◽  
M Tanzanu ◽  
G Vago ◽  
A Belvedere ◽  
D Parlanti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Univariate Analysis ◽  
Preoperative Assessment ◽  
High Volume ◽  
Ileocecal Resection ◽  
Tertiary Centre ◽  
Major Complications

Abstract Background Several risk factors for morbidity after surgery for Crohn’s disease of the terminal ileum have already been identified. However, the study population is rarely homogeneous, due to high-volume centres receiving patients treated in other hospitals with diverging medical protocols and different thresholds for surgical referral. A study including only patients undergoing homogeneous perioperative treatment in a single referral centre might reduce the selection bias. The aim of this study was to identify the risk factors for minor (Clavien-Dindo ≤2) and major (Clavien-Dindo ≥3) postoperative complications in patients who received medical treatment and surgery in a single centre. Methods Retrospective analysis of ileocecal resections for Crohn’s disease in biological era (2004–2019). Recurrence was excluded. Risk factors for minor and major complications were identified through univariate and multivariable logistic regression analyses. Variables were selected by univariate analysis with p &lt; 0.2 criteria, then a stepwise selection with entry criteria p = 0.05 and stay criteria p = 0.1. Results Of 631 patients included (59.4% male, median age 37 years), 214 (34%) had previous surgery and 152 (24.1%) biologics. Laparoscopy was feasible in 35.9% of cases, 285 patients (45.1%) required surgery on other bowel sites due to multiple locations or fistulae. 281 (44.5%) patients presented with fistulizing disease. Risk factors for 90-day minor complications (22.8%). Risk factors for 90-day major complications (6.8%). Conclusion Risk of minor complications was higher in younger patients, especially after a longer medical treatment. Fistulating disease increases the risks only if the rectum and sigmoid colon are involved. Major complications seem to be related to specific patient’s comorbidities, rather than disease characteristics. Onset of hypertension and neuro-vascular disease, known adverse events of chronic steroid use, should not be underestimated in the preoperative assessment of patients. Poor nutritional status greatly increased the risk of minor and major complications; therefore, any effort should be made towards the nutritional optimisation of Crohn’s patients

scholarly journals P377 Risk factors of rectal amputation for Crohn’s disease with perianal lesion

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S354-S355
Author(s):  
T Yokoo ◽  
S Yoshikawa ◽  
T Masuda ◽  
H Uchida ◽  
T Nakao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Large Intestine ◽  
Smoking Habit ◽  
Univariate Analysis ◽  
P Value ◽  
Permanent Stoma ◽  
Early Use

Abstract Background Recently, the importance of top-down therapy is emphasised for early Crohn’s Disease (CD). Especially early use of biologics after onset may prevent rectal amputation or permanent stoma concrete of CD with perianal lesion (CDp). The aim of this study was to evaluate the risk factors of permanent stoma concrete for CDp, and especially we had an interest for the relationship between permanent stoma concrete and length of time it takes for infliximab (IFX) was started to use after onset. Methods This is a comparative retrospective study of CDp patients who received IFX therapy at Kenseikai Nara Coloproctology Center between 2002 and 2018. We analysed risk factors of their rectal amputation using logistic regression analysis. Patients were included if they had perianal lesions and received IFX. The cases who received IFX after rectal amputation and who have missing values were excluded. Variables of interest included gender, age at onset and diagnosis, disease duration and location, disease behaviour, smoking, perianal surgical history, timing of IFX use after anoperineal lesion’s onset. Late IFX use was defined as we started to use IFX 2 years after perianal lesion’s onset. Results Fifty-four patients were recruited. Mean age was 37 years old, the ratio of males to females was 3.5. Forty-one patients’ disease was located in the small and large intestine, and thirteen patients’ were located in the large intestine. Median follow-up duration was 149 months. Among 54 patients, 10 patients were received rectal amputation or permanent stoma concrete. The univariate analysis revealed that the risk factors for rectal amputation were smoking habit (OR 7.56, 95% CI 1.41–53.88, p-value = 0.007), penetrating type (OR 6.44, 95% CI 1.21–39.22, p-value = 0.013) and Late IFX use (OR 12.47, 95% CI 1.50–589.26, p = 0.011). A multivariate analysis revealed that smoking habit (OR 21.5, 95% CI 1.92–239, p = 0.013) smoking behaviour (OR 21.5, 95% CI 1.92–239.00, p = 0.013) and Late IFX use (OR 16.0, 95% CI 1.01–254, p = 0.049) were independent risk factor for rectal amputation (Table 1). Conclusion Smoking and late IFX use may be a significant risk factor of rectal amputation for CDp. Early use of biologics may prevent permanent stoma concrete for CDp.

scholarly journals Assessment of Risk Factors for the Occurrence of a High-Output Ileostomy

2021 ◽  
Vol 8 ◽  
Author(s):  
Claudia Seifarth ◽  
Leonard N. Augustin ◽  
Kai S. Lehmann ◽  
Andrea Stroux ◽  
Johannes C. Lauscher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Surgical Procedure ◽  
Bowel Resection ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Small Bowel Resection ◽  
High Output

Background: Ileostomy is often required in patients undergoing bowel resections for inflammatory bowel diseases (IBD), colorectal cancer, and emergencies. Unfortunately, some patients develop a high-output stoma (HOS). This condition affects homeostasis and may be life threatening. We aimed to identify possible risk factors for the development of HOS.Patients and methods: From 2012 to 2018, 296 patients who underwent ileostomy at Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin were retrospectively analyzed. Emergency operations were included. Diverting ileostomy, end ileostomies and anastomotic stomata with at least part ileum, were examined. HOS was defined as stoma output of more than 1,000 mL per day for more than 3 days. Univariate and multivariable analyses were used to detect potential risk factors for the development of HOS.Results: 41 of 296 patients developed HOS (13.9%). Mortality was 0.3%. In the univariate analysis, age (p &lt; 0.002), diagnosis (Crohn's disease, p = 0.005), arterial hypertension (p = 0.023), surgical procedure (right-sided colectomy, small bowel resection, p &lt; 0.001), open technique (p &lt; 0.002), emergencies (p = 0.014), and anastomotic ileostomy (p &lt; 0.001) were identified as risk factors. In the multivariable logistic regression, older age, diagnosis (Crohn's disease) and surgical procedure (right-sided colectomy, separate ileostomy, small bowel resection) remained significant risk factors.Conclusion: The occurrence of HOS is a relevant problem after ileostomy. The identification of risk factors for a high-output may be helpful for monitoring, early diagnosis and initiation of therapy as well as in the planning of close follow-up care.

scholarly journals The risk factors for complications after Crohn’s Disease  surgery .

2021 ◽  
Author(s):  
Ilker Ozgur ◽  
Bora Karip ◽  
Cemil Burak Kulle ◽  
Bilger Cavus ◽  
Recep Ercin Sonmez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Demographic Data ◽  
Late Complication ◽  
Complication Rates ◽  
Abdominal Abscess ◽  
Colonic Involvement ◽  
Stoma Formation ◽  
The Mean

Abstract Background: Crohn’s disease needs a multidisciplinary approach and surgery will ultimately be necessary for most patients. Complications usually occur after surgery. Objective : This study aims to present complication rates in surgically treated Crohn's disease patients at a single institution and to determine possible risk factors. Methods: A retrospective analysis of 112 consecutive surgery performed on Crohn’s disease patients between 2003 and 2015. The demographic data, patient and disease characteristics, surgery type, and complications were analyzed. Results: Of 112 patients, 64 (57.1%) were male and 48 (42.9%) were female. The mean age was 34 (18-78) years. The mean follow-up was 114±32.4 (61-197) months. The most common early complications were intra-abdominal abscess formation (n=10, 8.9%) and wound infection (n=7, 6.26%). The incisional hernia was the most common late complication (n=4, 3.6%). Non-modifiable disease features associated with complications were colonic involvement of the disease (p=0.001), penetrating disease character (p=0.037), stoma formation (p=0.000), fistula (p=0.008) and concomitant fistula and intra-abdominal abscess (p=0.043) existence. Stoma formation was found to be an independent risk factor for complications (p=0.001). Conclusions: Colonic involvement, penetrating disease, fistula, concomitant abscess and fistula, and stoma formation were identified as non-modifiable risk factors for complications after surgery for Crohn’s disease.

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