Surgery in children with Crohn disease refractory to medical therapy
| Autor: | Simon R Clarke, John M Fell, Maurizio Pacilli, Simon Eaton, Munther J. Haddad, David Rawat |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Enterocutaneous fistula
medicine.medical_specialty Adolescent Perforation (oil well) Peritonitis Growth Anastomosis Weight Gain Inflammatory bowel disease Stoma symbols.namesake Hemoglobins Crohn Disease Recurrence Medicine Humans Elective surgery Child Fisher's exact test Growth Disorders Serum Albumin Retrospective Studies business.industry Gastroenterology medicine.disease Body Height Surgery Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health symbols business |
| Zdroj: | Journal of pediatric gastroenterology and nutrition. 52(3) |
| ISSN: | 1536-4801 |
| Popis: | Objective: The aim of this study was to evaluate the results of surgery in children with Crohn disease (CD) not responding to medical therapy and establish whether surgery improves growth and nutrition. Patients andMethods: Children with CD diagnosed between 1998 and 2008 were reviewed. Relapse was defined by Harvey-Bradshaw index >5. Data, reported as median (range), were compared by Fisher exact test and repeated-measures ANOVA.Results: One hundred forty-one children, ages 12.7 years (3.5-16.8), were identified; 27 (19%) required surgery 14.5 months (1.1-61.8) after diagnosis. Twenty-one had elective surgery (19 isolated ileocaecal disease and stricture, 2 diffuse disease of ileum); 6 had emergency surgery (3 peritonitis, 2 haemorrhage, 1 perforation). Surgery included 18 ileocaecal resection and end-to-end anastomosis, 5 stoma formation, 2 left hemicolectomy and end-to-end anastomosis, and 2 stricturoplasty. Follow-up was 2.5 years (1-9.4). Growth and nutrition improved by 6 and 12 months after surgery, with a significant increase in weight z score (P < 0.0001), height z score (P < 0.0001), albumin (30 [13-36] vs 39 [30-46] vs 40 [33-45], P < 0.0001), and haemoglobin [10 (6.8-13.2) vs 11.7 (8.2-13.7) vs 12.0 (9.3-14.7), P < 0.0001]. All patients of the received azathioprine (2-2.5mg . kg(-1) . day(-1)) after surgery. Fifteen patients (55%) relapsed with a modified Harvey-Bradshaw index of 8 (6-11) within 11.5 months (4.2-33.4). Of these, 5 patients (18%) relapsed within 1 year. Five patients (18%) had further surgery (2 anastomotic strictures, 2 diseased stoma, and 1 enterocutaneous fistula).Conclusions: Growth and nutrition following surgery for CD improve, but there is a high relapse rate. Despite this, the improved growth and nutrition before relapse may be beneficial during puberty and justify surgery in children not responding to medications. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text