Mattias Soop, Haroon Khan, Emma Nixon, Antje Teubner, Arun Abraham, Gordon Carlson, Simon Lal

Affiliates

Irving National Intestinal Failure Unit, Salford Royal Hospital, Manchester, UK

Abstract

Rationale:
Although intestinal failure (IF) is a feared complication in Crohn’s disease (CD), direct causes and outcomes of this complication have not been well described.

Methods:
Consecutive patients with CD and IF lasting >12 months and admitted 2000-2018 to a national IF centre were prospectively followed. Data were censored on 31 Jan 2019. Medians (range) are given. Longitudinal data were analysed by the Kaplan-Meier method.

Results:
121 patients (67 women) were included. IF occurred 14 (0-50) yrs after CD diagnosis. The cause of IF was an operation in 107 (88%) patients, and disease activity in 14 (12%).
Among the 107 patients with postoperative IF, the direct cause was an abdominal septic complication in 62 (51%) (an anastomotic dehiscence in 32, enteric fistulation in 25 and intra-abdominal abscess in 5), uncomplicated bowel resection in 38 (31%) and proximal diversion in 7 (6%).
Of the 32 patients with anastomotic dehiscence, corticosteroid therapy at the time of anastomosis was documented in 12, biologic therapy in 2, intraabdominal abscess in 3 and significant preoperative weight loss in 3.
31 of the 52 (60%) patients who underwent restorative surgery regained nutritional autonomy, as did 9 of the 69 patients (13%) who did not. On Kaplan-Meier analysis, 40% of all patients had regained nutritional autonomy after 10 years.

Conclusions:
IF is a severe complication of CD, with 60% permanently dependent on parenteral nutrition. The most frequent cause was an abdominal septic complication after abdominal surgery, in many cases following anastomosis in the presence of risk factors. Improved management of perioperative risk factors through preoperative optimisation, improved surgical technique and a judicious use of stomas may reduce the incidence of IF in CD.