TY - JOUR
T1 - Disease Recurrence and Long-Term Outcomes Following the Development of Intestinal Failure in Crohn's Disease
T2 - Over 20 Years of Experience from a National Reference Centre
AU - Kopczynska, Maja
AU - Crooks, Benjamin
AU - Deutsch, Liat
AU - Conley, Thomas
AU - Stansfield, Catherine
AU - Bond, Ashley
AU - Soop, Mattias
AU - Carlson, Gordon
AU - Lal, Simon
N1 - Publisher Copyright:
© 2023 The Author(s).
PY - 2023/12/1
Y1 - 2023/12/1
N2 - 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.
AB - 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.
KW - Crohn's disease
KW - intestinal failure
KW - outcomes
KW - recurrence
UR - http://www.scopus.com/inward/record.url?scp=85182886920&partnerID=8YFLogxK
U2 - 10.1093/ecco-jcc/jjad105
DO - 10.1093/ecco-jcc/jjad105
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C2 - 37343184
AN - SCOPUS:85182886920
SN - 1873-9946
VL - 17
SP - 1910
EP - 1919
JO - Journal of Crohn's and Colitis
JF - Journal of Crohn's and Colitis
IS - 12
ER -