title: Post-operative recurrence of Crohn's disease after definitive stoma: an underestimated risk.
abstract: BACKGROUND
  Crohn's disease (CD) is a progressive inflammatory disease affecting the entire gastrointestinal tract. The need for a definitive stoma (DS) is considered as the ultimate phase of damage. It is often believed that the risk of further disease progression is small when a DS has been performed.
  
  
  OBJECTIVE
  The goals of the study were to establish the rate of CD recurrence above the DS and to identify predictive factors of CD recurrence at the time of DS.
  
  
  METHODS
  We retrospectively reviewed all medical records of consecutive CD patients having undergone DS between 1973 and 2010. We collected clinical data at diagnosis, CD phenotype, treatment, and surgery after DS and mortality. Stoma was considered as definitive when restoration of continuity was not possible due to proctectomy, rectitis, anoperineal lesions (APL), or fecal incontinence. Clinical recurrence (CR) was defined as the need for re-introduction or intensification of medical therapy, and surgical recurrence (SR) was defined as a need for a new intestinal resection.
  
  
  RESULTS
  Eighty-three patients (20 males, 63 females) with a median age of 34 years at CD diagnosis were included. The median time between diagnosis and DS was 9 years. The median follow-up after DS was 10 years. Thirty-five patients (42%) presented a CR after a median time of 28 months (2-211) and 32 patients (38%) presented a SR after a median time of 29 months (4-212). In a multivariate analysis, APL (HR = 5.1 (1.2-21.1), p = 0.03) and colostomy at time of DS (HR = 3.8 (1.9-7.3), p = 0.0001) were associated factors with the CR.
  
  
  CONCLUSIONS
  After DS for CD, the risk of clinical recurrence was high and synonymous with surgical recurrence, especially for patients with APL and colostomy.
authors.affiliation: Digestive Surgery and Transplantation Unit, Hôpital Huriez, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.|Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France.
authors.forename: Dine
authors.initials: D
authors.lastname: Koriche
authors.affiliation: Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France.|Public Health, Epidemiology and Economic Health Unit, Registre Epimad, Maison Régionale de la Recherche Clinique, Centre Hospitalier Universitaire Régional, CS 70001, 59037, Lille Cedex, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Gower-Rousseau
authors.affiliation: Digestive Surgery and Transplantation Unit, Hôpital Huriez, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France. charbeliban@hotmail.com.|Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France. charbeliban@hotmail.com.
authors.forename: Charbel
authors.initials: C
authors.lastname: Chater
authors.affiliation: Biostatistics Unit, EA2694, Lille Nord de France University and Hospital, CHRU, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Unité de Biostatistique, Institut de Cancérologie de Lorraine, Vandoeuvre lès Nancy, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Salleron
authors.affiliation: Hepatogastroenterology Unit, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Tavernier
authors.affiliation: Hepatogastroenterology Unit, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.|Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France.|Hepatogastroenterology Unit, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pariente
authors.affiliation: Hepatogastroenterology Unit, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Cortot
authors.affiliation: Digestive Surgery and Transplantation Unit, Hôpital Huriez, Lille Nord de France University, Lille University Medical Center, F-59000, Lille, France.|Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Université Lille 2/CHRU de Lille; Equipe « IBD and environmental factors: Epidemiology and functional analyses, Lille University, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Zerbib
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003424:Crohn Disease / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors; D054047:Surgical Stomas / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colostomy; Crohn’s disease; Definitive stoma