scholarly journals The Role of Inflammation in Crohn’s Disease Recurrence after Surgical Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
B. Sensi ◽  
L. Siragusa ◽  
C. Efrati ◽  
L. Petagna ◽  
M. Franceschilli ◽  
...  

Introduction. Postoperative recurrence after surgery for Crohn’s disease (CD) is virtually inevitable, and its mechanism is poorly known. Aim. To review the numerous factors involved in CD postoperative recurrence (POR) pathogenesis, focusing on single immune system components as well as the immune system as a whole and highlighting the clinical significance in terms of preventive strategies and future perspectives. Methods. A systematic literature search on CD POR, followed by a review of the main findings. Results. The immune system plays a pivotal role in CD POR, with many different factors involved. Memory T-lymphocytes retained in mesenteric lymph nodes seem to represent the main driving force. New pathophysiology-based preventive strategies in the medical and surgical fields may help reduce POR rates. In particular, surgical strategies have already been developed and are currently under investigation. Conclusions. POR is a complex phenomenon, whose driving mechanisms are gradually being unraveled. New preventive strategies addressing these mechanisms seem promising.

2016 ◽  
Vol 2 (11) ◽  
Author(s):  
Adriana Georgiana Olariu ◽  
Liliana Bordeianou

<p>Crohn’s disease (CD) is a chronic inflammatory bowel disease with a relapsing, remitting course.  Approximately one in four CD patients requires surgery within five years of diagnosis. Unfortunately, surgery is rarely curative and up to 70% of CD patients experience endoscopic recurrence and 40% have clinical disease recurrence within 18 months after surgery.</p><p> </p><p>This review is aimed at providing internists and gastroenterologists a foundation for the management of patients who underwent ileocecal resection for CD. We provide an overview of the current definitions of postoperative recurrence and prognostic factors for postoperative CD recurrence. As recent studies raised concerns about the value of these factors, we examine the evidence behind the current risk stratification algorithm and pharmacologic treatment recommendations. Lastly, we discuss future directions for research.</p>


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S074-S075
Author(s):  
F Furfaro ◽  
A Zilli ◽  
V Craviotto ◽  
A Aratari ◽  
C Bezzio ◽  
...  

Abstract Background Prevention of postoperative recurrence is a critical goal in Crohn’s disease (CD) management. Currently, postsurgical CD management and treatment are based on endoscopic monitoring performed within the first year after surgery. However, colonoscopy (CS) is an invasive and expensive procedure, unpleasant to patients. A non-invasive and patient friendly approach is required. Methods Consecutive CD patients who underwent ileo-cecal resection from July 2017 to January 2020 were prospectively enrolled in three Italian Centers and performed CS and bowel ultrasound (US) after six months from the surgery, in a blinded fashion. The patients also underwent complete clinical assessment and blood and stool samples were obtained for C-reactive protein (CRP), and fecal calprotectin (FC) measurements. The disease was considered clinically active if the Harvey–Bradshaw Index (HBI) was higher than 4. Uni- and multivariable analyses were used to assess the correlation between non-invasive parameters, including bowel US findings and FC values and endoscopic recurrence, defined by a Rutgeerts’s score (RS) &gt; 2. Sensitivity, specificity, accuracy, PPV and NPV of bowel US parameters alone and in combination with FC in assessing endoscopic recurrence were calculated. Results Seventy patients were enrolled, 45 patients (64%) had an endoscopic recurrence (RS &gt; 2) at 6 months. Thirteen out of 45 (29%) were symptomatic (HBI &gt; 4). Bowel wall thickness (BWT), bowel wall flow (BWF, presence of vascular signals at color Doppler), the presence of mesenteric hypertrophy, the presence of limph-nodes and FC values significantly correlated with the endoscopic recurrence (p &lt; 0.005). Independent predictors for endoscopic recurrence were BWT (for 1-mm increase: OR 2.63; 95% CI 1.136.12; p= 0.024), presence of lymph-nodes (OR 23.24; 95% CI 1.85291.15; p= 0.014) and FC &gt; 50 µg/g (OR 11.86; 95% CI 2.60–54.09; p= 0.001). Sensitivity, specificity, accuracy, PPV and NPV of bowel US and/or FC are showed in Table 1. Table 1: Diagnostic accuracy of Bowel US and/or FC compared to CS in assessing endoscopic activity (CI 95%): per-patient analysis Conclusion Combined use of bowel US and FC is accurate in assessing endoscopic recurrence at 6 months in CD patients and represent a valid alternative to endoscopic assessment after surgery


2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S32-S33
Author(s):  
Ludovica Buttò ◽  
Paola Menghini ◽  
Natalia Aladyshkina ◽  
Kristine-Ann Buela ◽  
Carlo De Salvo ◽  
...  

Abstract Background Despite numerous therapeutic advancements, inflammatory bowel disease (IBD) remains a major health burden due to the inefficiency of conventional therapies. We recently demonstrated the role of death receptor 3 (DR3), a member of the tumor necrosis factor receptor (TNFR) superfamily and receptor for the cytokine TL1A, in regulating the balance between effector [T helper type 1 (TH)1,TH2,TH17] and regulatory T cells during murine Crohn’s disease (CD)-like ileitis. New evidence suggests a potential role of IL-9-secreting TH9 cells in the pathogenesis of IBD. However, the role of the TL1A/DR3 system in the differentiation and function of TH9 cells in CD is not fully understood. Thus, here, we investigated the role of a functional DR3 receptor in disease progression and activation of downstream signaling pathways relevant to TH9 cell differentiation and pathogenicity. Methods Ileal tissues were collected from 20-wk SAMP/YitFc (SAMP,WT) and DR3×SAMP (KO) mice, and analyzed by H&E, RT-qPCR and ELISA. CD4+ cells were purified by MACS sorting from mesenteric lymph nodes (MLNs) and spleens of WT and KO mice. TH9 cell were generated in medium supplemented with IL-4, TGF-β and TL1A. TH9 cells were analyzed by flow cytometry and cell supernatants by ELISA. TH9 cells (5x105) were adoptively transferred by i.p. injection into Rag2-/- mice, which were euthanized after 6-weeks. Colons were analyzed by H&E and MLNs were immunophenotyped by flow cytometry. Results Lack of DR3 ameliorated ileitis in SAMP (histologic score:5.2±1.3vs17.2±3.1, P≤0.0001, n=6), reduced of ∼ 50% the expression of Baft3, PU.1, il-9 mRNAs and IL-9 protein (P≤0.003, n=12), and 3-fold increased Id3 mRNA (P&lt;0.0007,n=12) in small intestinal tissues. CD4+-enriched TH9 cells from KO mice secreted 2-fold lower IL-9 and TNF (P≤0.0002,n=8), and 5-fold higher IL-10 protein level (P&lt;0.0001, n=8) than those from WT mice. Using the Rag2-/- T-cell transfer model of chronic colitis, we found that recipients of TH9 cells from KO donors developed less severe colitis (histologic score: 0.9±0.1vs3.9±0.8, P=0.005, n=5) and retained only half of the frequency of circulating TH9 cells in MLNs (P≤0.02,n=5) compared to those receiving WT TH9 cells, at 6-week after adoptive transfer. A similar experiment is currently ongoing to verify the impact of WT and KO TH9 cells on ileo-colitis development in SAMP×Rag2-/- mice. Conclusions The TL1A/DR3 system heavily contributes to IL-9-signaling pathway activation and it is required for the secretion of higher amount of IL-9 protein by TH9 cells in SAMP mice. KO TH9 cells were less colitogenic that those isolated from WT mice, indicating a crucial role of functional DR3 receptor in TH9 pathogenicity. Collectively, our results hold great translational significance by showing that modulation of DR3 signaling may be a novel therapeutic target for the treatment of CD.


2015 ◽  
Vol 148 (4) ◽  
pp. S-849
Author(s):  
Emily K. Wright ◽  
Michael A. Kamm ◽  
Fabiyola Selvaraj ◽  
Fred Princen ◽  
Peter De Cruz ◽  
...  

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
S. Ingallinella ◽  
M. Campanelli ◽  
A. Antonelli ◽  
C. Arcudi ◽  
V. Bellato ◽  
...  

An altered balance between effector and regulatory factors is supposed to sustain the tissue-damaging immune response in inflammatory bowel disease (IBD). Several studies demonstrate that severe active inflammation is a strong predictor for surgical complications and recurrence. Indeed, bowel resection in Crohn’s disease (CD) patients has a high surgical recurrence rate. In this review, we examined the IBD inflammatory pathways, the current surgical treatments, and the almost inevitable recurrence. The question that might arise is if the cure of intestinal CD is to be found in the surgical approach. A selective search of two databases (PubMed and the Cochrane Library) has been carried out without considering a specific time horizon as inclusion criteria. The scope of this literature review was investigating on the role of inflammation in the management of CD. The following key words have been used to develop the query string: (i) inflammation; (ii) Crohn’s disease; (iii) surgery; and (iv) postsurgical recurrence.


2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S055-S056
Author(s):  
S Bachour ◽  
R Shah ◽  
R Lyu ◽  
F Rieder ◽  
B Cohen ◽  
...  

Abstract Background There is conflicting data on the influence of surgical anastomosis configuration on endoscopic postoperative recurrence (POR) of Crohn’s disease (CD) following ileocolonic resection (ICR). Furthermore, whether this relationship differs by preoperative risk factors for POR has not been studied. We aimed to assess the role of ileocolonic anastomosis type on the rate and time to POR by preoperative POR risk. Methods Retrospective cohort study of adult CD patients who underwent ICR between 2009–2020 at a quaternary IBD referral center. Patients with a primary or secondary anastomosis and ≥1 postoperative colonoscopy were included. Endoscopic activity was assessed by modified Rutgeerts’ scoring. POR was defined as Rutgeerts’ ≥ i2b. Patients were categorized by anastomosis type: end-to-end (ETE), end-to-side (ETS), or side-to-side (STS). High-risk CD patients were defined by ≥1: age ≤ 30 years, active smoker, or ≥2 ICR for penetrating disease. Results 548 CD patients (52.6% female, age 35 y, 15.5% &gt; 1 prior ICR, 19.7% on biologic prophylaxis, 74.8% high-risk for POR) were included in the study (Figure 1). The majority received a STS (52.0%, N=285), 27.2% ETS, and 20.8% ETE. Patients with an ETE were diagnosed with CD at a younger age (p=0.04), had more penetrating disease (p=0.01), hand-sewn anastomoses (p &lt;0.001), and diverting loop ileostomies (p=0.02). There were no differences in prior ICR, smoking, biologic prophylaxis, or in median time from ICR to first post-operative colonoscopy (388.5 days, p=0.41) or POR detection (905 days, p=0.8) by anastomosis type. ETS patients had a shorter median follow-up time (3.9 y, p=0.02). The majority (55.7%) of all patients experienced POR (57% ETS; 55.4% STS; 54.4% ETE). Overall, there was no significant association between anastomosis type and POR rate (p=0.91) or time to POR (p=0.32). However, in high-risk CD patients, ETS was significantly associated with more rapid time to POR on log-rank (p=0.03) and multivariable Cox modeling (HR=1.51; p=0.04). Postoperative prophylactic biologic therapy initiated within 3 months of ICR significantly delayed POR in the overall cohort (HR=0.64; p=0.012) and the high-risk CD subgroup (HR=0.67; p=0.047). High-risk CD patients on prophylactic biologics had no difference in time to POR by anastomosis type (p=0.66). Conclusion In post-operative CD patients, there is no difference in rates of endoscopic recurrence by anastomosis configuration regardless of risk stratification. In high-risk patients, ETS was associated with more rapid endoscopic recurrence compared to other configurations, however prophylactic postoperative biologics may protect against this effect. Figure 2: KM Survival analysis of time (days) to POR


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