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%)
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,005 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
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 source (Gemma direct ou Codex distillé), 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 ».