Many patients with inflammatory bowel disease receive corticosteroids and 6-mercaptopurine/azathioprine during elective bowel surgery. We investigated the postoperative infection risk for patients undergoing elective bowel surgery who were receiving corticosteroids and/or 6-mercaptopurine/azathioprine before surgery compared with patients not receiving these medications.
A retrospective cohort study was conducted on 159 patients with inflammatory bowel disease who underwent elective bowel surgery. There were 56 patients receiving corticosteroids alone, 52 patients receiving 6-mercaptopurine/azathioprine alone or with corticosteroids, and 51 patients receiving neither corticosteroids nor 6-mercaptopurine/azathioprine. Postoperative infectious complications to time of discharge were categorized into major and minor complications.
Patients receiving corticosteroids had an adjusted odds ratio for any and major infectious complications of 3.69 (95% confidence interval [CI], 1.24-10.97) and 5.54 (95% CI, 1.12-27.26), respectively. The adjusted odds ratio for patients receiving 6-mercaptopurine/azathioprine for any and major infectious complications was 1.68 (95% CI, 0.65-4.27) and 1.20 (95% CI, 0.37-3.94), respectively.
Preoperative use of corticosteroids in patients with inflammatory bowel disease who are undergoing elective bowel surgery is associated with an increased risk of postoperative infectious complications. 6-Mercaptopurine/azathioprine alone and the addition of 6-mercaptopurine/azathioprine for patients receiving corticosteroids was not found to significantly increase the risk of postoperative infectious complications.
"Myrelid et al. found an independent increase in IASC from 6% in nontreated to 16% in patients treated with azathioprine. Such an association could not be confirmed in other studies   . There is a remarkable difference in findings between studies on IFX in Crohn's diseases and ulcerative colitis. "
[Show abstract][Hide abstract] ABSTRACT: There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease.
Retrospective study on 417 operations for Crohn's disease performed at four Danish hospitals in 2000-2007. Thirty-two patients were preoperatively treated with biologics and 166 were on immunomodulation. In total, 154 were treated with corticosteroids of which 66 had prednisolone 20 mg or more.
Anastomotic complications occurred at 13% of the operations. There were no difference in patients on biologic treatment (9% vs. 12% (p = 0.581)) or in patients on immunomodulation (10% vs. 14% (p = 0.263)). Patients on 20 mg prednisolone or more had more anastomotic complications (20% vs. 11% (p = 0.04)). Anastomotic complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p = 0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p = 0.014)), had longer disease duration (7.5 years vs. 4 years (p = 0.04)), longer operation time (155 min vs. 115 min (p = 0.018)) and more operative bleeding (200 ml vs. 130 ml (p = 0.029)). Multivariate analysis revealed preoperative treatment with prednisolone 20 mg or more, operation time and a colo-colic anastomosis as negative predictors of anastomotic complications.
Preoperative biologic treatment or immunomodulation had no influence on anastomotic complications. The study confirms previous findings of corticosteroids and a colo-colic anastomosis as negative predictors and also that surgical complexity, as expressed by bleeding and operation time, may contribute to anastomotic complications.
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung 5-Aminosalicylate (5-ASA) und Steroide gelten als Medikamente der Basistherapie bei Patienten mit chronisch entzndlichen Darmerkrankungen (CED). Whrend der Stellenwert von 5-ASA in der Therapie des Morbus Crohn (MC) zunehmend diskutiert wird, stellt die Colitis ulcerosa (CU) unverndert ihre Hauptindi- kation dar. In dieser Indikation spielen sie sowohl in der Akut- therapie eines milden bis moderaten Schubes als auch in der Remissionserhaltung eine wichtige Rolle. Zudem ist die Wirk- samkeit von topisch applizierten 5-ASA-Prparaten in der Lo- kaltherapie von milden bis moderaten Schben einer Proctitis ulcerosa bzw. linksseitigen Kolitis etabliert und ein additiver Ef- fekt zur oralen Therapie belegt. Der Nutzen von 5-ASA-Prpara- ten in der Chemoprevention CED-assoziierter kolorektaler Karzi- nome wird aus retrospektiven Studien vermutet. Steroide stellen die Therapie der ersten Wahl in der Behandlung des moderat bis stark aktiven Schubes sowohl bei MC als auch bei CU dar. Neben wirkungsarmen, topisch wirksamen Steroiden wie Budesonid soll bei mildem bis moderatem Schub eines primr ileozkalen MC mit oder ohne Befall des rechten Kolons der Vorzug gegeben werden, noch vor 5-ASA-Prparaten oder systemisch wirksamen Steroiden. Die Notwendigkeit einer systemischen Steroidthera- pie muss als prognostisch ungnstiger Indikator einer CED gese- hen werden und soll an den frhzeitigen therapeutischen Einsatz von Immunsuppressiva denken lassen. Eine Dauertherapie mit Abstract 5-aminosalicylates (5-ASA) and steroids constitute a cornerstone of medical therapy in patients with inflammatory bowel diseases (IBD). Whereas the efficacy of 5-ASA in Crohn's disease (CD) is equivocal, ulcerative colitis (UC) is the main indication for this drug. In UC, 5-ASA is effective in the treatment of mild to moder- ate acute disease and in maintenance of remission. Furthermore, 5-ASA topical therapy is an important treatment option in pa- tients with mild to moderate proctitis and/or left-sided UC and shows additive efficacy to oral therapy. From retrospective data a chemo-preventative activity of long-term 5-ASA therapy in UC is delineated. Steroids are treatment of first choice for moderate to severe cases of CD and UC. Budesonide, a modified steroid with less side effects, plays a major role in the treatment of ileo- colonic CD € involvement of the right colon and is used as treat- ment of choice in mild-to-moderate cases. In case of acute, se- vere disease conventional steroids are superior compared to budesonide and therefore budesonide should only be used after considerable improvement of disease activity. The necessity to apply steroids in a given patient represents a negative prognostic indicator for the course of disease and should incite the early in- troduction of immunosuppressive therapy in this case. Steroids are only effective as short term therapy of IBD and are to be avoided for maintenance treatment. In all cases of steroid ther- apy an osteoporosis prophylaxis with calcium and vitamin D is
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