S1143 End Ostomy in Crohn's Disease: Insights From the Cleveland Clinic Inflammatory Bowel Disease Ostomy Research Registry
Notice bibliographique
Résumé
Introduction: Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), often requires surgical intervention. Permanent end ostomy (EO) is needed in 8% of UC and over 10% of CD patients, significantly impacting quality of life and clinical management. Previous studies on IBD patients with EO have been limited by small sample sizes, heterogeneous data, and short follow-up. This study aims to provide detailed descriptive data on CD patients who underwent EO from the Cleveland Clinic IBD Ostomy Research Registry. Methods: This is a retrospective single institution study using the first ever comprehensive registry comprising IBD patients with EO created at age 18 or older with at least 6 months of follow up after EO. Data was collected on various demographic, clinical, and surgical variables and analysis was made using R Studio. Results: 125 patients (77 CD, 48 UC) were included. In the CD cohort, 75 (97.4%) patients had an end- ileostomy, while 2 (2.6%) had an end-colostomy. The mean time from ostomy surgery to the last follow- up was 8.23 (±10.7). The mean age at diagnosis was 28.4 (±16.9) years, and the mean age at ostomy surgery was 41.4 (±15.5) years. The median time from diagnosis to surgery was 13.0 (±10.5) years. Patients were predominantly female (59.7%) and white (90.9%). A family history of IBD was reported by 28 (36.4%) patients. Half of the patients (50%) were never smokers. Regarding disease characteristics, 39 (54.2%) patients had a history of prior bowel surgery, with an average of 2.90 (±1.75) surgeries per patient. The pattern of disease was predominantly ileocolonic in 43 (55.8%) patients and penetrating in 46 (59.7%) patients. Extra-intestinal manifestations were present in 40.3% of patients, most commonly peripheral arthritis (20.8%). Pre-ostomy medication use was reported by 75 (97.4%) patients, with infliximab and azathioprine/6-mercaptopurine use each reported in 41 (53.2%) patients. Fifty (64.9%) patients reported a history of pre-ostomy oral corticosteroid use. Conclusion: Preliminary analysis of the ongoing Cleveland Clinic IBD Ostomy Research Registry offers valuable insights that could inform future clinical practice and research. This study provides a detailed demographic and clinical profile of CD patients with history of EO, highlighting the significant disease burden and surgical history in this population (see Table 1). Table 1. - Demographic and clinical characteristics of Crohn’s disease patients in the Cleveland Clinic Inflammatory Bowel Disease Ostomy Research Registry Variable Population Characteristics Patients (n=77, percent) Age (years) Age at diagnosis 28.4 (±16.9) Age at ostomy surgery 41.4 (±15.5) Time from diagnosis to surgery 13.0 (±10.5) Time from ostomy surgery to last follow-up 8.23 (±10.7) Sex Female 46 (59.7%) Male 31 (40.3%) Race/Ethnicity white 70 (90.9%) Black or African American 2 (2.6%) Hispanic or Latino 1 (1.3%) American Indian or Alaska Native 1 (1.3%) Multiracial/Multicultural 3 (3.9%) Family History of IBD Family History of CD 19 (24.7%) Family History of UC 9 (11.7%) Tobacco History Never 38 (50.0%) Former (quit >2 weeks) 28 (36.8%) Active 10 (13.2%) Weight Body Mass Index (BMI) 27.0 (±7.11) Disease Location and Behavior History of Perianal Involvement 55 (72.4%) History of Prior Bowel Surgery 39 (54.2%) Number of Bowel Surgeries 2.90 (±1.75) Extra-Intestinal Manifestations History of Extra-Intestinal Manifestations 31 (40.3%) Peripheral arthritis (arthritis of extremities) 16 (20.8%) Axial arthritis (arthritis of spine) 5 (6.49%) Uveitis 3 (3.90%) Pyoderma gangrenosum 5 (6.49%) Erythema Nodosum 6 (7.79%) Primary Sclerosing Cholangitis 1 (1.30%) Medications Pre-ostomy Medications 75 (97.4%) Montreal Classification Terminal ileum (L1) 5 (6.49%) Colon only (L2) 30 (39.0%) Ileocolonic (L3) 43 (55.8%) Upper GI (L4) 3 (3.90%) CD Location Jejunum/proximal ileum 8 (10.4%) Terminal ileum 44 (57.1%) Colon 71 (92.2%) Rectum 43 (55.8%) CD Behavior Inflammatory 32 (41.6%) Stricturing 28 (36.4%) Penetrating 46 (59.7%)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».