Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study
Background. Postoperative endoscopic recurrence (PER) is common in patients with Crohn’s disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear. Methods. The postoperative management of CD patients undergoi...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2020/8618574 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832561600463110144 |
|---|---|
| author | Shasha Tang Wei Liu Weilin Qi Tunan Yu Qian Cao Xiaolong Ge Wei Zhou |
| author_facet | Shasha Tang Wei Liu Weilin Qi Tunan Yu Qian Cao Xiaolong Ge Wei Zhou |
| author_sort | Shasha Tang |
| collection | DOAJ |
| description | Background. Postoperative endoscopic recurrence (PER) is common in patients with Crohn’s disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear. Methods. The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. Colonoscopies were performed within one year after surgery. Clinical data and risk factors for endoscopic recurrence were analyzed focusing on postoperative pharmacological prophylaxis. Results. All patients were at a high risk of postoperative recurrence according to the AGA guidelines. PER occurred in 29 (28.7%) of these patients. The overall PER rate was 39.2% at one year. The PER rate in patients treated with nitroimidazole, thiopurines, infliximab, or a combination of thiopurines and infliximab for postoperative prophylaxis was 88.1%, 34.1%, 20.5%, and 0%, respectively. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, P=0.01; HR: 0.36, 95% CI: 0.15-0.86, P=0.02). In addition, further investigation revealed that educational background was the main factor related to patients’ nonadherence to AGA guidelines. Conclusions. The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Thiopurines and infliximab are effective in preventing endoscopic recurrence. Guideline nonadherence is associated with PER at one year, thus indicating that there is room for improvement in adherence to the AGA guidelines. |
| format | Article |
| id | doaj-art-ead6f281fb4e493388a0022d5782c5fd |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-ead6f281fb4e493388a0022d5782c5fd2025-02-03T01:24:39ZengWileyGastroenterology Research and Practice1687-61211687-630X2020-01-01202010.1155/2020/86185748618574Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort StudyShasha Tang0Wei Liu1Weilin Qi2Tunan Yu3Qian Cao4Xiaolong Ge5Wei Zhou6Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaInflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaDepartment of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, ChinaBackground. Postoperative endoscopic recurrence (PER) is common in patients with Crohn’s disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear. Methods. The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. Colonoscopies were performed within one year after surgery. Clinical data and risk factors for endoscopic recurrence were analyzed focusing on postoperative pharmacological prophylaxis. Results. All patients were at a high risk of postoperative recurrence according to the AGA guidelines. PER occurred in 29 (28.7%) of these patients. The overall PER rate was 39.2% at one year. The PER rate in patients treated with nitroimidazole, thiopurines, infliximab, or a combination of thiopurines and infliximab for postoperative prophylaxis was 88.1%, 34.1%, 20.5%, and 0%, respectively. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, P=0.01; HR: 0.36, 95% CI: 0.15-0.86, P=0.02). In addition, further investigation revealed that educational background was the main factor related to patients’ nonadherence to AGA guidelines. Conclusions. The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Thiopurines and infliximab are effective in preventing endoscopic recurrence. Guideline nonadherence is associated with PER at one year, thus indicating that there is room for improvement in adherence to the AGA guidelines.http://dx.doi.org/10.1155/2020/8618574 |
| spellingShingle | Shasha Tang Wei Liu Weilin Qi Tunan Yu Qian Cao Xiaolong Ge Wei Zhou Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study Gastroenterology Research and Practice |
| title | Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study |
| title_full | Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study |
| title_fullStr | Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study |
| title_full_unstemmed | Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study |
| title_short | Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study |
| title_sort | real world experience with aga guidelines in the management of crohn s disease following ileocolonic resection a retrospective cohort study |
| url | http://dx.doi.org/10.1155/2020/8618574 |
| work_keys_str_mv | AT shashatang realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy AT weiliu realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy AT weilinqi realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy AT tunanyu realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy AT qiancao realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy AT xiaolongge realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy AT weizhou realworldexperiencewithagaguidelinesinthemanagementofcrohnsdiseasefollowingileocolonicresectionaretrospectivecohortstudy |