Colectomy in refractory Crohn's colitis improves nutrition and reduces steroid use

Aodhnait S. Fahy, D. Dean Potter, Anupama Ravi, Yannis Reissis, William Alvis Faubion, Jeanne Tung

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Pediatric patients with severe refractory Crohn's colitis (CC) may require total colectomy (TC) or diverting loop ileostomy (DLI). Our understanding of outcomes (postoperative complications, nutrition and restoration of intestinal continuity) is currently limited. Methods: Pediatric patients with severe CC who underwent TC or DLI were identified. Demographics, pre and postoperative anthropometric and biochemical data, surgical complications and medication requirements were recorded. Results: Twenty-seven patients (TC = 22, DLI = 5) with a median age of 15.0. years (range 3-18) were identified, 64% male with a median follow-up of 45. months (range 3-120). Mean weight and BMI improved for TC patients by 1. year postoperatively - weight z-score from -1.08 to -0.54 (p = 0.02), BMI z-score from -0.83 to -0.38 (p = 0.04), with a non-significant height change from - 0.79 to -0.65 (p = 0.07). Mean hemoglobin and albumin both also improved - 9.88. g/dl to 11.76. g/dl (p = 0.003) and 3.44. g/dl to 4.03. g/dl (p = 0.004) respectively. These measures did not significantly improve after DLI. Most TC patients (59%) had attempted restoration of intestinal continuity with 45% in continuity at end of follow-up. One DLI patient underwent ileostomy takedown but subsequently needed re-diversion. Conclusions: In severe CC, TC offers an opportunity to improve nutrition and growth, with a reasonable likelihood of restoring intestinal continuity. Level of evidence: Level IV - Case series.

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - 2017

Fingerprint

Ileostomy
Colectomy
Colitis
Steroids
Pediatrics
Weights and Measures
Albumins
Hemoglobins
Demography
Growth

Keywords

  • Colectomy
  • Colitis
  • Crohn's
  • Diversion
  • Growth
  • Surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Colectomy in refractory Crohn's colitis improves nutrition and reduces steroid use. / Fahy, Aodhnait S.; Potter, D. Dean; Ravi, Anupama; Reissis, Yannis; Faubion, William Alvis; Tung, Jeanne.

In: Journal of Pediatric Surgery, 2017.

Research output: Contribution to journalArticle

Fahy, Aodhnait S. ; Potter, D. Dean ; Ravi, Anupama ; Reissis, Yannis ; Faubion, William Alvis ; Tung, Jeanne. / Colectomy in refractory Crohn's colitis improves nutrition and reduces steroid use. In: Journal of Pediatric Surgery. 2017.
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abstract = "Background: Pediatric patients with severe refractory Crohn's colitis (CC) may require total colectomy (TC) or diverting loop ileostomy (DLI). Our understanding of outcomes (postoperative complications, nutrition and restoration of intestinal continuity) is currently limited. Methods: Pediatric patients with severe CC who underwent TC or DLI were identified. Demographics, pre and postoperative anthropometric and biochemical data, surgical complications and medication requirements were recorded. Results: Twenty-seven patients (TC = 22, DLI = 5) with a median age of 15.0. years (range 3-18) were identified, 64{\%} male with a median follow-up of 45. months (range 3-120). Mean weight and BMI improved for TC patients by 1. year postoperatively - weight z-score from -1.08 to -0.54 (p = 0.02), BMI z-score from -0.83 to -0.38 (p = 0.04), with a non-significant height change from - 0.79 to -0.65 (p = 0.07). Mean hemoglobin and albumin both also improved - 9.88. g/dl to 11.76. g/dl (p = 0.003) and 3.44. g/dl to 4.03. g/dl (p = 0.004) respectively. These measures did not significantly improve after DLI. Most TC patients (59{\%}) had attempted restoration of intestinal continuity with 45{\%} in continuity at end of follow-up. One DLI patient underwent ileostomy takedown but subsequently needed re-diversion. Conclusions: In severe CC, TC offers an opportunity to improve nutrition and growth, with a reasonable likelihood of restoring intestinal continuity. Level of evidence: Level IV - Case series.",
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AB - Background: Pediatric patients with severe refractory Crohn's colitis (CC) may require total colectomy (TC) or diverting loop ileostomy (DLI). Our understanding of outcomes (postoperative complications, nutrition and restoration of intestinal continuity) is currently limited. Methods: Pediatric patients with severe CC who underwent TC or DLI were identified. Demographics, pre and postoperative anthropometric and biochemical data, surgical complications and medication requirements were recorded. Results: Twenty-seven patients (TC = 22, DLI = 5) with a median age of 15.0. years (range 3-18) were identified, 64% male with a median follow-up of 45. months (range 3-120). Mean weight and BMI improved for TC patients by 1. year postoperatively - weight z-score from -1.08 to -0.54 (p = 0.02), BMI z-score from -0.83 to -0.38 (p = 0.04), with a non-significant height change from - 0.79 to -0.65 (p = 0.07). Mean hemoglobin and albumin both also improved - 9.88. g/dl to 11.76. g/dl (p = 0.003) and 3.44. g/dl to 4.03. g/dl (p = 0.004) respectively. These measures did not significantly improve after DLI. Most TC patients (59%) had attempted restoration of intestinal continuity with 45% in continuity at end of follow-up. One DLI patient underwent ileostomy takedown but subsequently needed re-diversion. Conclusions: In severe CC, TC offers an opportunity to improve nutrition and growth, with a reasonable likelihood of restoring intestinal continuity. Level of evidence: Level IV - Case series.

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