Inflammatory Response in Patients With Crohn's Disease Compared With Ulcerative Colitis: Secondary Results of a Prospective Pilot Study. Issue 4 (28th November 2022)

• Record Type: Journal Article
• Authors: El-Hussuna, Alaa; Varghese, Chris; Bhat, Vivek; Qvist, Niels
• Is Part Of: Crohn's & colitis 360. Volume 4:Issue 4(2022)
• Publication Date: 2022-11-28
• Subjects: Crohn's disease -- ulcerative colitis -- surgery -- inflammatory response -- inflammatory bowel disease; Crohn's disease -- Periodicals; Colitis -- Periodicals; 616.344
• DOI: 10.1093/crocol/otac047
• Languages: English
• ISSNs: 2631-827X

Abstract

Abstract: Background: The aim of this study was to compare the inflammatory response (IR) to surgery between patients with Crohn's disease (CD) and patients with ulcerative colitis (UC). Methods: This study is a secondary analysis of data collected in a previous study by the authors. We included all adult patients who underwent elective surgery for CD and UC. The primary outcome variable was the difference in postoperative IR as measured by interleukin 6 (IL-6), interleukin 10 (IL-10), C-reactive protein (CRP), and the count of white blood cells (WBCs) in peripheral blood. Two-way repeated-measures analysis of variance with a mixed effect (disease type as the between-patient factor, and time as the within patient factor). Results: We included 46 patients in this pilot study. Median age was 42.5 years (IQR 30.5–42.2), 25/46 were females (54.3%). Patients with CD had a more marked IR to surgery compared with those with UC as shown by significant differences in levels of IL-6, IL-10, and CRP. Patients with CD were more often treated with postoperative epidural analgesia 17 (53.1%) versus 1 (7.1%), P = .009. Patients with colonic CD had a more intense IR to surgery than patients with UC after the same surgical resection. This significant trend continued when patients who underwent small bowel resection compared with those with colectomy. The changes in inflammatory markers and WBC counts from baseline to peak value were also higher in patients with CD indicating a more severe IR. However, there was a similar response in patients undergoing laparoscopic compared with open approaches Conclusions: The postoperative IR was greater in patients with CD than those with UC. This is important to tackle in preoperative optimization as well as postoperative recovery protocols. Lay Summary: This study showed that patients with Crohn's disease react with more inflammation to surgery than patients with ulcerative colitis. This finding indicates that Crohn's patients may need more preparation before surgery, and more monitoring after it. Graphical Abstract: