ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2021
Antitumour necrosis factor therapy is associated with de novo Crohn's disease after ileal pouch-anal anastomosis.
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 9 citations in OpenAlex.
- Extensive Disease and Exposure to Multiple Biologics Precolectomy Is Associated with Endoscopic Cuffitis Post-Ileal Pouch-Anal Anastomosis in Patients With Ulcerative Colitis.Inflammatory bowel diseases · 2025Article
- Acute Severe Ulcerative Colitis Is Associated With an Increased Risk of Acute Pouchitis.Inflammatory bowel diseases · 2023Article
- Predictors of pouch failure: A tertiary care inflammatory bowel disease centre experience.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2023Article
- Ileal Pouch-Anal Anastomosis in the Older Adult: a Review of Postoperative Outcomes and Pouchitis Treatment.Current treatment options in gastroenterology · 2022Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
aimTumour necrosis factor inhibitors (TNFi) have revolutionized the management of moderate to severe ulcerative colitis (UC) since their approval for UC in 2005. However, many patients ultimately require surgery with ileal pouch-anal anastomosis (IPAA). Development of de novo Crohn's disease (CD) following IPAA is an increasingly common and devastating complication, sometimes progressing to pouch failure. The aim of this study was to evaluate the association of preoperative TNFi exposure and the development of de novo CD after IPAA.
methodA prospective single-centre inflammatory bowel disease (IBD) registry was searched for consecutive patients with UC undergoing IPAA during a 25-year period ending July 2018. Patients with preoperative CD or IBD-unclassified were excluded. De novo CD was diagnosed upon endoscopic evidence of five or more mucosal ulcers proximal to the ileal pouch any time after surgery and/or pouch fistula occurring more than three months after ileostomy closure.
resultsThe study cohort consisted of 400 patients with a median follow-up of 44.0 (IQR 11-113) months. Sixty-two (16%) patients developed de novo CD 28.0 (IQR 6-67) months following ileostomy closure. Survival analysis of TNFi era patients revealed a significant increase in de novo CD risk in those with preoperative TNFi exposure. Multivariable proportional hazards modelling revealed two independent predictors for de novo CD development: older age was protective (HR 0.89 per 5-year increase; P = 0.009) and preoperative TNFi exposure was hazardous (HR 2.10; P = 0.011).
conclusionThis prospective study is the first to suggest an association between preoperative TNFi exposure and the development of de novo CD.
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