Management and outcomes of surgical patients with intestinal Behçet's disease and Crohn's disease in southwest China

Li Zeng; Wen-Jian Meng; Zhong-Hui Wen; Yi-Long Chen; Yu-Fang Wang; Cheng-Wei Tang

doi:10.12998/wjcc.v9.i16.3858

Management and outcomes of surgical patients with intestinal Behçet's disease and Crohn's disease in southwest China

World J Clin Cases. 2021 Jun 6;9(16):3858-3868. doi: 10.12998/wjcc.v9.i16.3858.

Authors

Li Zeng¹, Wen-Jian Meng², Zhong-Hui Wen¹, Yi-Long Chen³, Yu-Fang Wang⁴, Cheng-Wei Tang¹

Affiliations

¹ Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
² Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
³ West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China.
⁴ Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. wangyufang04@126.com.

Abstract

Background: Gastrointestinal involvement in Behçet's disease (GIBD) and Crohn's disease (CD) are inflammatory diseases sharing a considerable number of similarities. However, different from CD, the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.

Aim: To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.

Methods: We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University. A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited. Information including demographic data, medication, and operative and postoperative parameters were collected and analyzed. As the incidence of surgical GIBD is low, their detailed medical records were reviewed and compared to previous studies. Moreover, the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.

Results: Indication for first surgery was often acute intestinal perforation for GIBD patients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P = 0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CD patients. Approximately 40% of patients with GIBD and 23.6% of patients with CD developed postoperative complications, 50% of patients with GIBD and 38.7% of patients with CD had recurrence postoperatively, and 40% (4/10) of patients with GIBD and 26.4% (28/106) of patients with CD underwent reoperations. The average period of postoperative recurrence was 7.87 mo in patients with Behçet's disease (BD) and 10.43 mo in patients with CD, whereas the mean duration from first surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CD patients. Surgical patients with GIBD more often used corticosteroids (6/10 vs 7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively, whereas surgical patients with CD often used infliximab (27/106), azathioprine, or 6-mercaptopurine (74/106) for maintenance therapy.

Conclusion: Patients suffering GIBD require surgery mostly under emergency situations, which may be more susceptible to recurrence and reoperation and need more aggressive postoperative treatment than patients with CD.

Keywords: Biological agents; Crohn’s disease; Gastrointestinal involvement in Behçet's disease; Postoperative treatment; Real-world study; Surgery.