Definitions, diagnosis, and management of postoperative recurrence in Crohn's disease patients with permanent ileostomy-a systematic review and meta-analysis.
Alessandro Armuzzi, Parakkal Deepak, Claire E Parker, Brian G Feagan, Christopher Ma, Vipul Jairath, Vineet Ahuja, Miguel Regueiro, Gerhard Rogler, Florian Rieder, Siddharth Singh, Katherine Falloon, Neil Nero, Julie Ann Van Koughnett, Jeffrey D McCurdy, Suha Abushamma, Tesfaye Yadete, Clifton Fulmer, Iris Dotan, Neeraj Narula, Axel Dignass, Jonas Halfvarson, David H Bruining, Stefan D Holubar, Yuhong Yuan, Virginia Solitano, Julian Panés, Tim Raine, Willem Bemelman, Ailsa Hart, Antonino Spinelli, Fernando Magro, Maria T Abreu, Rupert W Leong, Sudheer K Vuyyuru, Miles P Sparrow
Journal: Journal of Crohn's & colitis
2025;19(4):
PMID: 40066499
Abstract
BACKGROUND AND AIMS
Over 10% of patients with Crohn's disease require permanent ileostomy. We aimed to summarize the existing data on diagnosis, definitions of recurrence, and management of Crohn's disease patients with permanent ileostomy.
METHODS
MEDLINE, Embase, and CENTRAL databases were searched from inception to February 6, 2024. Randomized controlled trials, cohort and cross-sectional studies, and case series of more than 5 patients reporting on postoperative recurrence or the need for surgery in patients with Crohn's disease and permanent ileostomy were included. Search results were independently screened, and full text of all titles meeting eligibility criteria was obtained. Outcomes of interest included diagnostic techniques, recurrence definitions, and management approaches. We estimated pooled rates (with 95% confidence interval [CI]) of recurrence.
RESULTS
Thirty cohort studies including 2055 Crohn's patients with permanent ileostomy were included (53% female, median age at the time of ileostomy creation 32 years, the most common reason for ileostomy was refractory disease). The postoperative recurrence rate was 27% (95% CI, 21.3-33.3, 26 studies, 451/1805 patients). Modalities for diagnosis of Crohn's disease recurrence were symptoms (15 studies), endoscopy (4 studies), histology from endoscopic biopsies (2 studies), imaging (5 studies), and surgery (22 studies). The reported definitions of recurrence for each modality were heterogeneous.
CONCLUSIONS
There is a lack of standardized monitoring tools and criteria for diagnosing recurrence in patients with Crohn's disease and permanent ileostomy. The results of this systematic review will form the basis of a global expert recommendation exercise focused on developing management standards and trial endpoints for this condition.
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Address:
Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States.; Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic Foundation, Cleveland, OH, United States.; Alimentiv Inc, London, Ontario, Canada.; Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai, Los Angeles, CA, United States.; Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.; IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.; Department of Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands.; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States.; Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.; Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt Am Main, Germany.; Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.; Alimentiv Inc, London, Ontario, Canada.; Division of Gastroenterology, Department of Medicine, Western University, London, Onatario, Canada.; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.; Department of Pathology, Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, OH, United States.; Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.; Inflammatory Bowel Disease Unit, St Mark's Hospital, London, United Kingdom.; Department of Colon and Rectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, United States.; Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.; Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.; Alimentiv Inc, London, Ontario, Canada.; Inflammatory Bowel Disease Unit, Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada.; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.; Faculty of Medicine, CINTESIS@RISE, University of Porto, Porto, Portugal.; Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottawa, Ontario, Canada.; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.; Formerly Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.; Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.; Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, United States.; Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.; Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, United States.; Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.; Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.; Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy.; Division of General Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.; Alimentiv Inc, London, Ontario, Canada.; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.; Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.; Lawson Health Research Institute, London, Ontario, Canada.; Alimentiv Inc, London, Ontario, Canada.; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.; Division of Gastroenterology, Department of Medicine, Western University, London, Onatario, Canada.; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.; Program for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, United States.
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