title: Natural history of Crohn's disease following total colectomy and end ileostomy.
abstract: BACKGROUND
  Crohn's disease (CD) requires surgical management in up to two-thirds of patients. Few studies have addressed the issue of ileal recurrence after colectomy and permanent ileostomy. The aims of our study were to assess the rate and predictors of postoperative recurrence of CD in patients with permanent ileostomy.
  
  
  METHODS
  In a retrospective study from a tertiary referral center, we analyzed the natural history of patients with CD who underwent total colectomy and permanent ileostomy. Our primary outcomes were (1) overall disease recurrence including luminal recurrence, perianal disease or peristomal lesions requiring therapy, and (2) luminal recurrence alone defined as endoscopic and clinical recurrence within the terminal ileum. We examined if patient characteristics predicted recurrence using multivariate Cox proportional hazard models.
  
  
  RESULTS
  Our study included 73 patients with CD followed for a mean of 28 months (range, 0-168 mo) after total colectomy and permanent ileostomy. Twenty patients had overall disease recurrence within 10 years after surgery, at rates of 15% and 50% at 1 and 5 years, respectively. Rate of luminal recurrence was 8% and 35% at 1 and 5 years, respectively. Diagnosis at age less than 18 years (hazard ratio, 2.94; 95% confidence interval, 1.14-7.62) and anti-tumor necrosis factor therapy before surgery (hazard ratio, 4.75; 95% confidence interval, 1.25-18.13) were the only independent predictive factors for overall disease recurrence.
  
  
  CONCLUSIONS
  Up to one-third of patients with CD have overall recurrence of disease after treatment with total colectomy and permanent ileostomy. There is need to develop algorithms for surveillance and management of this select subgroup of patients.
authors.affiliation: *Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; and ‡Harvard Medical School, Boston, Massachusetts.
authors.forename: Joanna
authors.initials: J
authors.lastname: Lopez
authors.forename: Gauree G
authors.initials: GG
authors.lastname: Konijeti
authors.forename: Deanna D
authors.initials: DD
authors.lastname: Nguyen
authors.forename: Jenny
authors.initials: J
authors.lastname: Sauk
authors.forename: Vijay
authors.initials: V
authors.lastname: Yajnik
authors.forename: Ashwin N
authors.initials: AN
authors.lastname: Ananthakrishnan
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult