title: Outcomes with Anti-Tumour Necrosis Factor-Alpha Therapy and Serology in Patients with Denovo Crohn's Disease After Ileal Pouch Anal Anastomosis.
abstract: OBJECTIVE
  A subset of patients who undergo ileal pouch-anal anastomosis [IPAA] for ulcerative colitis [UC] will later be diagnosed with denovo Crohn's disease [CD]. These patients have a higher risk of pouch failure. In this study we evaluated inflammatory bowel disease [IBD] serology in patients with denovo CD and examined the success of anti-tumour necrosis factor-alpha [anti-TNFα] therapy in preventing ileostomy in denovo CD patients who failed anti-TNFα therapy before IPAA.
  
  
  METHODS
  A prospectively maintained database of patients undergoing IPAA was reviewed to identify patients who developed denovo CD [defined as small bowel inflammation above the pouch inlet or pouch fistula/perianal disease appearing more than 3 months after stoma closure]. Clinical characteristics and IBD serology were analysed. Treatment failure was defined as pouch failure requiring ileostomy or pouchectomy.
  
  
  RESULTS
  Of 350 patients included in the study, 92 [26%] patients developed denovo CD. Significantly more denovo CD patients had anti-I2 positivity postoperatively versus preoperatively [p = 0.007]. Anti-TNFα therapy successfully treated denovo CD in 28 out of 38 [74%] patients. Out of 17 patients with denovo CD who had failed to respond to anti-TNFα agents before surgery and were treated with anti-TNFα therapy after surgery, 12 [71%] patients responded to treatment.
  
  
  CONCLUSIONS
  I2 serology may possibly help identify patients who have developed or are at risk for developing denovo CD. Anti-TNFα therapy for denovo CD after IPAA can help prevent permanent ileostomy in almost 75% of cases, even in patients who previously failed anti-TNFα treatment before surgery.
authors.affiliation: Departments of Medicine, Colon and Rectal Surgery.
authors.forename: Lori
authors.initials: L
authors.lastname: Robbins
authors.affiliation: Gastroenterology.
authors.forename: Karen
authors.initials: K
authors.lastname: Zaghiyan
authors.affiliation: and Pediatrics.
authors.forename: Gil
authors.initials: G
authors.lastname: Melmed
authors.affiliation: and Pediatrics.
authors.forename: Eric
authors.initials: E
authors.lastname: Vasiliauskas
authors.affiliation: Departments of Medicine, Colon and Rectal Surgery.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: and Pediatrics.
authors.forename: Dermot
authors.initials: D
authors.lastname: McGovern
authors.affiliation: Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Shervin
authors.initials: S
authors.lastname: Rabizadeh
authors.affiliation: Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Namita
authors.initials: N
authors.lastname: Singh
authors.affiliation: and Pediatrics.
authors.forename: Carol
authors.initials: C
authors.lastname: Landers
authors.affiliation: and Pediatrics.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ippoliti
authors.affiliation: and Pediatrics.
authors.forename: David
authors.initials: D
authors.lastname: Shih
authors.affiliation: and Pediatrics.
authors.forename: Stephan
authors.initials: S
authors.lastname: Targan
authors.affiliation: Gastroenterology PFleshner@aol.com.
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D039021:Colonic Pouches; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: Biomarkers; surgery