title: Risk of permanent stoma in extensive Crohn's colitis: the impact of biological drugs.
abstract: OBJECTIVE
  The overall risk of permanent stoma was determined in patients with extensive Crohn's colitis. An attempt was made to analyse whether biological drugs have modified the surgical approach in patients with anorectal involvement.
  
  
  METHODS
  In all, 233 patients with Crohn's disease colitis operated on between 1995 and 2010 were reviewed retrospectively. Fifty-one were treated before 2002 (prebiological era) and 182 after 2002 (biological era). The relationship was determined between the use of immunosuppressors, biological drugs, the presence of perianal disease and anorectal stenosis and the rate of permanent stoma formation.
  
  
  RESULTS
  In the prebiological era 23 (45.1%) patients without anorectal involvement underwent colectomy and ileorectal anastomosis, 17 (33.3%) with severe anorectal disease had proctocolectomy and 11 (21.6%) with anorectal involvement had abdominal colectomy with permanent ileostomy. In the biological era 73 (40.1%) patients without anorectal involvement underwent colectomy and ileorectal anastomosis, nine (5%) with severe anorectal involvement had proctocolectomy and 100 (54.9%) with anorectal involvement had colectomy with terminal ileostomy. Of these 100, 75 have subsequently been treated with biological drugs with full regression of anorectal lesions in 81.3%. Rates of permanent stoma in the prebiological and biological era were 60.8% and 19.2% (P < 0.001). Univariate and multivariate analysis showed that only the use of biological drugs was significantly associated with an increased rate of rectal preservation (P < 0.05).
  
  
  CONCLUSIONS
  The risk of a permanent stoma in patients with Crohn's colitis and anorectal involvement is significantly reduced with combined surgical and biological treatment.
authors.affiliation: Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Coscia
authors.forename: L
authors.initials: L
authors.lastname: Gentilini
authors.forename: S
authors.initials: S
authors.lastname: Laureti
authors.forename: P
authors.initials: P
authors.lastname: Gionchetti
authors.forename: F
authors.initials: F
authors.lastname: Rizzello
authors.forename: M
authors.initials: M
authors.lastname: Campieri
authors.forename: C
authors.initials: C
authors.lastname: Calabrese
authors.forename: G
authors.initials: G
authors.lastname: Poggioli
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D003082:Colectomy / Q000379:methods*; D003092:Colitis / Q000209:etiology / Q000601:surgery*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn's colitis; anorectal involvement; biological drugs; ileorectal anastomosis; permanent ileostomy