Section of Gastroenterology, Department of Medicine, Lenox Hill Hospital, 100 East 77th Street, 6 Black Hall, New York, NY, 10075, USA.
Dig Dis Sci. 2018 Feb;63(2):446-451. doi: 10.1007/s10620-017-4873-7. Epub 2017 Dec 28.
Ulcerative colitis (UC) patients with progression of their disease despite optimized medical therapy may warrant "curative" proctocolectomy with end ileostomy or ileo-anal pouch (IPAA) anastomosis. The aim of our study was to assess the incidence of later recurrent ileitis that lead to altering the initial diagnosis to Crohn's disease (CD).
A retrospective analysis was conducted on the inflammatory bowel disease database at Lenox Hill Hospital. The database consisted of patients that were diagnosed with UC or CD based on clinical assessment, endoscopic appearance, gross and histological examination, and imaging between 1960 and 2015. The post-colectomy follow-up period was at least 10 years. Recurrent disease was classified by evidence of transmural inflammation in the distal ileum, fistulizing disease, or stricturing disease.
From our IBD database, we identified 128 patients who underwent elective or urgent colectomy with the preoperative diagnosis of UC. Thirty-two (25%) had either an IPAA or end ileostomy with documented recurrence of inflammation in the small bowel mucosa consistent with CD. There was no significant difference between the type of surgical approach and the chance of recurrent disease (p = .20). The average time to clinically significant recurrence was 5 years.
The incidence of recurrent CD following colectomy for ulcerative colitis, when followed postoperatively for an average of 20 years, was 25%, considerably more than previously reported. Patients who come to colectomy for ulcerative colitis and are followed for at least 10 years show a high incidence of recurrent Crohn's disease in the ileostomy or ileo-anal pouch. Extended follow-up should be included in patients coming to colectomy for ulcerative colitis before they should be considered cured of their disease.
尽管经过优化的药物治疗，溃疡性结肠炎（UC）患者的病情仍在进展，可能需要进行“治愈性”的结肠直肠切除术，并进行末端回肠造口术或回肠肛管吻合术（IPAA）。我们的研究目的是评估导致初始诊断改变为克罗恩病（CD）的迟发性回肠炎的发生率。
我们对 Lenox Hill 医院的炎症性肠病数据库进行了回顾性分析。该数据库包含了 1960 年至 2015 年间通过临床评估、内镜表现、大体和组织学检查以及影像学诊断为 UC 或 CD 的患者。术后随访时间至少 10 年。复发疾病通过远端回肠的黏膜透壁炎症、瘘管性疾病或狭窄性疾病的证据进行分类。
从我们的 IBD 数据库中，我们确定了 128 例接受择期或紧急结肠切除术且术前诊断为 UC 的患者。32 例（25%）接受了 IPAA 或末端回肠造口术，术后远端回肠黏膜炎症复发，与 CD 相符。手术方式与疾病复发的几率之间无显著差异（p=0.20）。临床显著复发的平均时间为 5 年。
溃疡性结肠炎行结肠切除术，术后平均随访 20 年，CD 复发率为 25%，明显高于以往报道。接受溃疡性结肠炎结肠切除术并随访至少 10 年的患者，在回肠造口或回肠肛管吻合术后出现回肠克罗恩病复发的发生率较高。在考虑溃疡性结肠炎患者治愈疾病之前，应包括对接受结肠切除术的患者进行长期随访。
