To operate or not? Teens with isolated ileal CD

Oct 27, 2015 - E-Mentoring in IBD | Volume 8 • 2015

Issue 21

Clinical Question

In teenagers diagnosed with isolated ileal Crohn’s disease (CD), what are the long-term effects of surgical resection on disease severity, medication use, and growth?

Editor’s Bottom Line

Surgical resection of isolated ileal CD provides a durable clinical response and needs to remain in the armamentarium of the gastroenterologist.

Reference

Kulungowski AM, Acker SN, Hoffenberg EJ, et al. Initial operative treatment of isolated ileal Crohn’s disease in adolescents. Am J Surg. 2015;210:141–5.
https://www.ncbi.nlm.nih.gov/pubmed/25457242

Synopsis

In this retrospective study, pediatric patients diagnosed with terminal ileum CD who underwent surgical resection (2002 to 2013) were included. Each patient was postoperatively followed for an average of 2 years. Data was collected regarding CD severity, medication use, and growth.

A total of 26 patients were enrolled, with a mean age of 15.7 ± 2.5 years. The mean age at diagnosis was 14.1 ± 2.6 years. The need for surgery was attributed to stricture, abscess, fistula, obstruction, perforation, or any combination of two or more of these. Elective resection was performed in 58% of the patients. During follow-up, 84.6% (22/26) of the patients reported clinical improvement. The use of steroids (69% vs. 12%, P<0.0001) and immunosuppressives (54% vs. 31%) significantly decreased between the pre- and post-operative periods. Those taking biologics preoperatively (31%) continued with them in the postoperative period with no new patients using them.

Both BMI and weight increases were significant when comparing the pre- and post-operative rates. Height increases were also recorded but these were not significant.

Details

Study Design: Retrospective cohort study
Funding: None
Allocation: N/A
Setting: Colorado
Level of Evidence: 2a (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.