Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective: To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods: The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. Results: In the current study, there was no statistically significant difference between surgical and medical patients in terms of extraintestinal manifestations (p =0.25). On the contrary, there were statistically significant differences between surgical and medical patients in terms of perianal disease (p <0.001) and granuloma (p =0.012). Surgical patients were more likely to have perianal disease and granulomas. Peri-anal disease was negative predictor of surgical treatment. In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p <0.001) and Mayo score for UC (p <0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. Conclusion: Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment.