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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 4/2017

01-04-2017 | Original Article

Post-operative recurrence of Crohn’s disease after definitive stoma: an underestimated risk

Authors: Dine Koriche, Corinne Gower-Rousseau, Charbel Chater, Alain Duhamel, Julia Salleron, Noémie Tavernier, Jean-Frédéric Colombel, Benjamin Pariente, Antoine Cortot, Philippe Zerbib

Published in: International Journal of Colorectal Disease | Issue 4/2017

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Abstract

Introduction

Crohn’s disease (CD) is a progressive inflammatory disease affecting the entire gastrointestinal tract. The need for a definitive stoma (DS) is considered as the ultimate phase of damage. It is often believed that the risk of further disease progression is small when a DS has been performed.

Aims

The goals of the study were to establish the rate of CD recurrence above the DS and to identify predictive factors of CD recurrence at the time of DS.

Methods

We retrospectively reviewed all medical records of consecutive CD patients having undergone DS between 1973 and 2010. We collected clinical data at diagnosis, CD phenotype, treatment, and surgery after DS and mortality. Stoma was considered as definitive when restoration of continuity was not possible due to proctectomy, rectitis, anoperineal lesions (APL), or fecal incontinence. Clinical recurrence (CR) was defined as the need for re-introduction or intensification of medical therapy, and surgical recurrence (SR) was defined as a need for a new intestinal resection.

Results

Eighty-three patients (20 males, 63 females) with a median age of 34 years at CD diagnosis were included. The median time between diagnosis and DS was 9 years. The median follow-up after DS was 10 years. Thirty-five patients (42%) presented a CR after a median time of 28 months (2–211) and 32 patients (38%) presented a SR after a median time of 29 months (4–212). In a multivariate analysis, APL (HR = 5.1 (1.2–21.1), p = 0.03) and colostomy at time of DS (HR = 3.8 (1.9–7.3), p = 0.0001) were associated factors with the CR.

Conclusion

After DS for CD, the risk of clinical recurrence was high and synonymous with surgical recurrence, especially for patients with APL and colostomy.
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Metadata
Title
Post-operative recurrence of Crohn’s disease after definitive stoma: an underestimated risk
Authors
Dine Koriche
Corinne Gower-Rousseau
Charbel Chater
Alain Duhamel
Julia Salleron
Noémie Tavernier
Jean-Frédéric Colombel
Benjamin Pariente
Antoine Cortot
Philippe Zerbib
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 4/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2707-2

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