Postsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis.

Hdl Handle:
http://hdl.handle.net/10147/128451
Title:
Postsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis.
Authors:
Cunningham, Michael F; Docherty, Neil G; Coffey, J Calvin; Burke, John P; O'Connell, P Ronan
Affiliation:
Surgical Professorial Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Citation:
Postsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis. 2010, 34 (7):1615-26 World J Surg
Journal:
World journal of surgery
Issue Date:
Jul-2010
URI:
http://hdl.handle.net/10147/128451
DOI:
10.1007/s00268-010-0504-6
PubMed ID:
20195604
Abstract:
A pressing need exists to identify factors that predispose to recurrence after terminal ileal resection for Crohn's disease (CD) and to determine effective prophylactic strategies. This review presents an up-to-date summary of the literature in the field and points to a role for bacterial overproliferation in recurrence.; The literature (Medline, Embase, and the Cochrane Library, 1971-2009) on ileal CD and postoperative recurrence was searched, and 528 relevant articles were identified and reviewed.; Smoking is a key independent risk factor for recurrence. NOD2/CARD15 polymorphisms and penetrating phenotype are associated with aggressive disease and higher reoperation rates. Age at diagnosis, disease duration, gender, and family history are inconsistent predictors of recurrence. Prophylactic 5-aminosalicylic acid therapy and nitromidazole antibiotics are beneficial. Combination therapies with immunosuppressants are also effective. Anti-TNFalpha-based regimens show benefit but the evidence base is small. Corticosteroid, interleukin-10, and probiotic therapies are not effective. Wider, stapled anastomotic configurations are associated with reduced recurrence rates. Strictureplasty and laparoscopic approaches have similar long-term recurrence rates to open resection techniques. Length of resection and presence of microscopic disease at resection margins do not influence recurrence. A lack of consensus exists regarding whether the presence of granulomas or plexitis affects outcome.; Current evidence points to defects in mucosal immunity and intestinal dysbiosis of either innate (NOD2/CARD15) or induced (smoking) origin in postoperative CD recurrence. Prophylactic strategies should aim to limit dysbiosis (antibiotics, side-to-side anastomoses) or prevent downstream chronic inflammatory sequelae (anti-inflammatory, immunosuppressive, and immunomodulatory therapy).
Item Type:
Article
Language:
en
MeSH:
Crohn Disease; Frameshift Mutation; Genetic Predisposition to Disease; Homeostasis; Humans; Ileitis; Ileum; Laparoscopy; Life Style; Nod2 Signaling Adaptor Protein; Recurrence; Risk Factors; Smoking
ISSN:
1432-2323

Full metadata record

DC FieldValue Language
dc.contributor.authorCunningham, Michael Fen
dc.contributor.authorDocherty, Neil Gen
dc.contributor.authorCoffey, J Calvinen
dc.contributor.authorBurke, John Pen
dc.contributor.authorO'Connell, P Ronanen
dc.date.accessioned2011-04-20T15:04:25Z-
dc.date.available2011-04-20T15:04:25Z-
dc.date.issued2010-07-
dc.identifier.citationPostsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis. 2010, 34 (7):1615-26 World J Surgen
dc.identifier.issn1432-2323-
dc.identifier.pmid20195604-
dc.identifier.doi10.1007/s00268-010-0504-6-
dc.identifier.urihttp://hdl.handle.net/10147/128451-
dc.description.abstractA pressing need exists to identify factors that predispose to recurrence after terminal ileal resection for Crohn's disease (CD) and to determine effective prophylactic strategies. This review presents an up-to-date summary of the literature in the field and points to a role for bacterial overproliferation in recurrence.-
dc.description.abstractThe literature (Medline, Embase, and the Cochrane Library, 1971-2009) on ileal CD and postoperative recurrence was searched, and 528 relevant articles were identified and reviewed.-
dc.description.abstractSmoking is a key independent risk factor for recurrence. NOD2/CARD15 polymorphisms and penetrating phenotype are associated with aggressive disease and higher reoperation rates. Age at diagnosis, disease duration, gender, and family history are inconsistent predictors of recurrence. Prophylactic 5-aminosalicylic acid therapy and nitromidazole antibiotics are beneficial. Combination therapies with immunosuppressants are also effective. Anti-TNFalpha-based regimens show benefit but the evidence base is small. Corticosteroid, interleukin-10, and probiotic therapies are not effective. Wider, stapled anastomotic configurations are associated with reduced recurrence rates. Strictureplasty and laparoscopic approaches have similar long-term recurrence rates to open resection techniques. Length of resection and presence of microscopic disease at resection margins do not influence recurrence. A lack of consensus exists regarding whether the presence of granulomas or plexitis affects outcome.-
dc.description.abstractCurrent evidence points to defects in mucosal immunity and intestinal dysbiosis of either innate (NOD2/CARD15) or induced (smoking) origin in postoperative CD recurrence. Prophylactic strategies should aim to limit dysbiosis (antibiotics, side-to-side anastomoses) or prevent downstream chronic inflammatory sequelae (anti-inflammatory, immunosuppressive, and immunomodulatory therapy).-
dc.language.isoenen
dc.subject.meshCrohn Disease-
dc.subject.meshFrameshift Mutation-
dc.subject.meshGenetic Predisposition to Disease-
dc.subject.meshHomeostasis-
dc.subject.meshHumans-
dc.subject.meshIleitis-
dc.subject.meshIleum-
dc.subject.meshLaparoscopy-
dc.subject.meshLife Style-
dc.subject.meshNod2 Signaling Adaptor Protein-
dc.subject.meshRecurrence-
dc.subject.meshRisk Factors-
dc.subject.meshSmoking-
dc.titlePostsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis.en
dc.typeArticleen
dc.contributor.departmentSurgical Professorial Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.en
dc.identifier.journalWorld journal of surgeryen
dc.description.provinceLeinster-

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