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Abdalla, M., Norblad, R., Olsson, M., Landerholm, K., Andersson, P., Söderholm, J. D., . . . Myrelid, P. (2020). Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients. Digestive Diseases and Sciences, 250-259
Open this publication in new window or tab >>Anorectal Function After Ileo-Rectal Anastomosis Is Better than Pelvic Pouch in Selected Ulcerative Colitis Patients
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2020 (English)In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, p. 250-259Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With a lifelong perspective, 12% of ulcerative colitis patients will need a colectomy. Further reconstruction via ileo-rectal anastomosis or pouch can be affected by patients' perspective of their quality of life after surgery.

AIM: To assess the function and quality of life after restorative procedures with either ileo-rectal anastomosis or ileal pouch-anal anastomosis in relation to the inflammatory activity on endoscopy and in biopsies.

METHOD: A total of 143 UC patients operated with subtotal colectomy and ileo-rectal anastomosis or pouches between 1992 and 2006 at Linköping University Hospital were invited to participate. Those who completed the validated questionnaires (Öresland score, SF-36, Short Health Scale) were offered an endoscopic evaluation including multiple biopsies. Associations between anorectal function and quality of life with type of restorative procedure and severity of endoscopic and histopathologic grading of inflammation were evaluated.

RESULTS: Some 77 (53.9%) eligible patients completed questionnaires, of these 68 (88.3%) underwent endoscopic evaluation after a median follow-up of 12.5 (range 3.5-19.4) years after restorative procedure. Patients with ileo-rectal anastomosis reported better overall Öresland score: median = 3 (IQR 2-5) for ileo-rectal anastomosis (n = 38) and 10 (IQR 5-15) for pouch patients (n = 39) (p < 0.001). Anorectal function (Öresland score) and endoscopic findings (Baron-Ginsberg score) were positively correlated in pouch patients (tau: 0.28, p = 0.006).

CONCLUSION: Patients operated with ileo-rectal anastomosis reported better continence compared to pouches. Minor differences were noted regarding the quality of life. Ileo-rectal anastomosis is a valid option for properly selected ulcerative colitis patients if strict postoperative endoscopic surveillance is carried out.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2020
Keywords
Ileal pouch-anal anastomosis, Ileo-rectal anastomosis, Quality of life, Ulcerative colitis
National Category
Surgery Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-160247 (URN)10.1007/s10620-019-05757-6 (DOI)31372911 (PubMedID)2-s2.0-85070104240 (Scopus ID)
Available from: 2019-09-13 Created: 2019-09-13 Last updated: 2020-03-09Bibliographically approved
Bolckmans, R., Kalman, T. D., Singh, S., Ratnatunga, K. C., Myrelid, P., Travis, S. & George, B. D. (2020). Does Smoking Cessation Reduce Surgical Recurrence After Primary Ileocolic Resection for Crohns Disease?. Diseases of the Colon & Rectum, 63(2), 200-206
Open this publication in new window or tab >>Does Smoking Cessation Reduce Surgical Recurrence After Primary Ileocolic Resection for Crohns Disease?
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2020 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 63, no 2, p. 200-206Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Tobacco smoking is a known risk factor for recurrence of Crohns disease after surgical resection. OBJECTIVE: This study assessed the effect of smoking cessation on long-term surgical recurrence after primary ileocolic resection for Crohns disease. DESIGN: A retrospective review of a prospectively maintained database was conducted. SETTINGS: Patient demographic data and medical and surgical details were combined from 2 specialist centers. After ethical approval, patients were contacted in case of missing data regarding smoking habit. PATIENTS: All patients undergoing ileocolic resection between 2000 and 2012 for histologically confirmed Crohns disease were included. Those with previous intestinal resection, strictureplasty for Crohns disease, leak after ileocolic resection, or who were never reversed were excluded. MAIN OUTCOME MEASURES: The primary end point was surgical recurrence measured by Kaplan-Meier survival analysis and secondary medical therapy at time of follow-up. RESULTS: Over a 12-year period, 290 patients underwent ileocolic resection. Full smoking data were available for 242 (83%) of 290 patients. There were 169 nonsmokers (70%; group 1), 42 active smokers at the time of ileocolic resection who continued smoking up to last follow-up (17%; group 2), and 31 (13%) who quit smoking after ileocolic resection (group 3). The median time of smoking exposure after ileocolic resection for group 3 was 3 years (interquartile range, 0-6 y), and median follow-up time for the whole group was 112 months (9 mo; interquartile range, 84-148 mo). Kaplan-Meier survival analysis showed a significantly higher surgical recurrence rate for group 2 compared with group 3 (16/42 (38%) vs 3/31 (10%); p = 0.02; risk ratio = 3.9 (95% CI, 1-12)). In addition, significantly more patients in group 2 without surgical recurrence received immunomodulatory maintenance therapy compared with group 3 (12/26 (46%) vs 4/28 (14%); p = 0.01; risk ratio = 3.2 (95% CI, 1-9)). LIMITATIONS: The study was limited by its retrospective design and small number of patients. CONCLUSIONS: Smoking cessation after primary ileocolic resection for Crohns disease may significantly reduce long-term risk of surgical recurrence and is associated with less use of maintenance therapy. See Video Abstract at http://links.lww.com/DCR/B86.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
Keywords
Crohns disease; Ileocolic resection; Smoking cessation; Surgical recurrence
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-163660 (URN)10.1097/DCR.0000000000001547 (DOI)000509508700011 ()31842162 (PubMedID)2-s2.0-85077761704 (Scopus ID)
Note

Funding Agencies|National Institute for Health Research Oxford Biomedical Research CentreNational Institute for Health Research (NIHR)

Available from: 2020-02-18 Created: 2020-02-18 Last updated: 2020-03-03Bibliographically approved
Torres, J., Bonovas, S., Doherty, G., Kucharzik, T., Gisbert, J. P., Raine, T., . . . Fiorino, G. (2020). ECCO Guidelines on Therapeutics in Crohns Disease: Medical Treatment. Journal of Crohn's & Colitis, 14(1)
Open this publication in new window or tab >>ECCO Guidelines on Therapeutics in Crohns Disease: Medical Treatment
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2020 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 14, no 1Article in journal (Refereed) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Oxford University Press, 2020
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-164399 (URN)10.1093/ecco-jcc/jjz180 (DOI)000517278200002 ()31711158 (PubMedID)2-s2.0-85077222955 (Scopus ID)
Note

Funding Agencies|European Crohns and Colitis Organisation

Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2020-03-26Bibliographically approved
Myrelid, P. (2018). Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery?. Alimentary Pharmacology and Therapeutics, 48(3), 383-384
Open this publication in new window or tab >>Editorial: post-operative complications in elderly onset inflammatory bowel disease-what is surgery, what is disease, and what is delay of surgery?
2018 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 48, no 3, p. 383-384Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-150247 (URN)10.1111/apt.14833 (DOI)000438337100018 ()29998499 (PubMedID)2-s2.0-85049788203 (Scopus ID)
Note

Funding Agencies|Janssen; Takeda; MSD

Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-22Bibliographically approved
Landerholm, K., Abdalla, M., Myrelid, P. & Andersson, R. (2017). Survival of ileal pouch anal anastomosis constructed after colectomy or secondary to a previous ileorectal anastomosis in ulcerative colitis patients: a population-based cohort study. Scandinavian Journal of Gastroenterology, 52(5), 531-535
Open this publication in new window or tab >>Survival of ileal pouch anal anastomosis constructed after colectomy or secondary to a previous ileorectal anastomosis in ulcerative colitis patients: a population-based cohort study
2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 5, p. 531-535Article in journal (Refereed) Published
Abstract [en]

Objectives: Ileorectal anastomosis (IRA) affects bowel function, sexual function and reproduction less negatively than ileal pouch anal anastomosis (IPAA), the standard reconstruction after colectomy for ulcerative colitis (UC). In younger UC patients, IRA may have a role postponing pelvic surgery and IPAA. The aim of the present study was to investigate the survival of IPAA secondary to IRA compared to IPAA as primary reconstruction, as this has not previously been studied in UC. Patients and methods: All patients with UC diagnosis between 1960 and 2010 in Sweden were identified from the National Patient Registry. From this cohort, colectomized patients reconstructed with primary IPAA and patients reconstructed with IPAA secondary to IRA were identified. The survival of the IPAA was followed up until pouch failure, defined as pouchectomy and ileostomy or a diverting ileostomy alone. Results: Out of 63,796 patients, 1796 were reconstructed with IPAA, either primarily (n=1720) or secondary to a previous IRA (n=76). There were no demographic differences between the groups, including length of follow-up (median 12.6 (IQR 6.7-16.6) years and 10.0 (IQR 3.5-15.9) years, respectively). Failure of the IPAA occurred in 103 (6.0%) patients with primary and in 6 (8%) patients after secondary IPAA (P=0.38 log-rank). The 10-year pouch survival was 94% (95% CI 93-96) for primary IPAA and 92% (81-97) for secondary. Conclusions: Patients choosing IRA as primary reconstruction do not have an increased risk of failure of a later secondary IPAA in comparison with patients with primary IPAA.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Ulcerative colitis; inflammatory bowel disease; ileal pouch anal anastomosis; ileoanal pouches; ileoanal reservoir; pelvic pouches; ileorectal anastomosis; restorative proctocolectomy; pouch failure; pouch survival
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-136233 (URN)10.1080/00365521.2016.1278457 (DOI)000395746800006 ()28102092 (PubMedID)
Note

Funding Agencies|Bengt Ihres Fund; Medical Research Council of Southeast Sweden; Futurum - Academy for Health and Care; Region Jonkoping County, Sweden

Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2019-11-04
Marti-Gallostra, M., Myrelid, P., Mortensen, N., Keshav, S., Travis, S. P. & George, B. (2017). The role of a defunctioning stoma for colonic and perianal Crohns disease in the biological era. Scandinavian Journal of Gastroenterology, 52(3), 251-256
Open this publication in new window or tab >>The role of a defunctioning stoma for colonic and perianal Crohns disease in the biological era
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 3, p. 251-256Article in journal (Refereed) Published
Abstract [en]

Objective: A defunctioning stoma is a therapeutic option for colonic or perianal Crohns disease. In the pre-biologic era the response rate to defunctioning in our unit was high (86%), but intestinal continuity was only restored in 11-20%. Few data exist on the outcome of defunctioning since the widespread introduction of biologicals. Material and methods: All patients undergoing a defunctioning stoma for colonic/perianal Crohns disease since 2003-2011 were identified from a prospective database. Indications for surgery, medical therapy, response to defunctioning and long-term clinical outcome were recorded. Successful restoration of continuity was defined as no stoma at last follow up. Results: Seventy-six patients were defunctioned (57 with biologicals) and at last follow up, 20 (27%) had continuity restored. Early clinical response rate (amp;lt;3 months) was 15/76 (20%) and overall response 31/76 (41%). Complex anal fistulae/stenosis were associated with a very low chance of restoring continuity (10% and 0%, respectively), while colitis was associated with a higher chance of restoring continuity (48%). Endoscopic or histological improvement in colitis after defunctioning was associated with a higher rate of restoring continuity (10/16, 63%) compared to no such improvement (4/15, 27%, p=0.05). Those failing biologics had similar chance of restoration as those not receiving biologics, 15/57 (26%) and 5/19 (26%), respectively. Conclusion: Overall response to colonic defunctioning was 41%. Successful restoration of continuity occurred in 27%, but 48% in the absence of perianal disease. Response is appreciably less in the pre-biologic era, so patient and physician expectations need to be managed appropriately.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-134778 (URN)10.1080/00365521.2016.1205127 (DOI)000392488800001 ()27855530 (PubMedID)
Available from: 2017-02-24 Created: 2017-02-24 Last updated: 2018-05-02
Jakobsson, G. L., Sternegard, E., Olen, O., Myrelid, P., Ljung, R., Strid, H., . . . Ludvigsson, J. F. (2017). Validating inflammatory bowel disease (IBD) in the Swedish National Patient Register and the Swedish Quality Register for IBD (SWIBREG). Scandinavian Journal of Gastroenterology, 52(2), 216-221
Open this publication in new window or tab >>Validating inflammatory bowel disease (IBD) in the Swedish National Patient Register and the Swedish Quality Register for IBD (SWIBREG)
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 2, p. 216-221Article in journal (Refereed) Published
Abstract [en]

Background: Both the Swedish National Patient Register (NPR) and the Swedish Quality Register for inflammatory bowel disease (IBD, SWIBREG) are important sources of research data and information. However, the validity of a diagnosis of IBD in these registers is unknown. Methods: Medical charts of 129 randomly selected patients from the NPR and 165 patients registered both in SWIBREG and the NPR were reviewed. Patients were classified according to standardized criteria for ulcerative colitis (UC), Crohns disease (CD), or IBD unclassified (IBD-U). Positive predictive values (PPVs) for UC, CD, IBD-U (only SWIBREG), or having any form of IBD were then calculated. Results: For cases with amp;gt;= 2 diagnoses of IBD in the NPR (hospitalizations or non-primary care outpatient visits), the PPV was 93% (95% CI: 87-97) for any IBD, 79% (66-88) for UC and 72% (60-82) for CD. In UC patients with amp;gt;= 2 UC diagnoses but never a CD diagnosis, the PPV increased to 90% (77-97). The PPV for CD in patients with amp;gt;= 2 CD diagnoses but never a UC diagnosis was 81% (67-91)). Combining data from SWIBREG (amp;gt;= 1 record) and the NPR (amp;gt;= 1 record), the PPV was 99% for any IBD (97-100), 96% (89-99) for UC, and 90% (82-96) for CD. Conclusion: The validity of the UC, CD, and IBD diagnoses is high in the NPR but even higher when cases were identified both in SWIBREG and the NPR. These results underline the need for a well-functioning Swedish Quality Register for IBD as a complement to the NPR.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keywords
Inflammatory bowel disease; validation; National Patient Register
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-134619 (URN)10.1080/00365521.2016.1246605 (DOI)000392488000017 ()27797278 (PubMedID)
Note

Funding Agencies|Swedish Quality Register for IBD (SWIBREG)

Available from: 2017-02-21 Created: 2017-02-21 Last updated: 2018-05-02
Gerdin, L., Eriksson, A. S., Olaison, G., Sjödahl, R., Ström, M., Söderholm, J. D. & Myrelid, P. (2016). The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohns Disease. Journal of Crohn's & Colitis, 10(1), 50-54
Open this publication in new window or tab >>The Swedish Crohn Trial: A Prematurely Terminated Randomized Controlled Trial of Thiopurines or Open Surgery for Primary Treatment of Ileocaecal Crohns Disease
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2016 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 10, no 1, p. 50-54Article in journal (Refereed) Published
Abstract [en]

Background and aims: The importance of efficient and safe treatment of Crohns disease is highlighted by its chronicity. Both medical and surgical treatments have shown good results in the symptomatic control of limited ileocaecal Crohns disease. The aim of this study was to compare medical treatment with surgical treatment of ileocaecal Crohns disease. Methods: Thirty-six patients from seven hospitals with primary ileocaecal Crohns disease were randomized to either medical or surgical treatment. The medical treatment was induction of remission with budesonide and thereafter maintenance treatment with azathioprine. The surgical treatment was open ileocaecal resection. Crohns disease activity index over time, expressed as area under the curve at 1, 3 and 5 years, was the primary endpoint. Subjective health measured with the 36-item Short Form Survey Instrument (SF36) and a visual analogue scale (VAS) were secondary endpoints. Results: There were no differences between the treatment groups in Crohns disease activity index over time. General health, measured as SF36 score, was higher in patients receiving surgical treatment than in those receiving medical treatment at 1 year, but there was no corresponding difference in VAS. Due to the slow inclusion rate and changes in clinical practice, the study was t = erminated prematurely. Conclusion: The study ended up being underpowered and should be interpreted with caution, but there was no clinically significant difference between the two treatment arms. Further studies are needed to address this important clinical question.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2016
Keywords
Surgery; clinical trials; quality of life; socio-economical and psychological endpoints
National Category
Clinical Medicine Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-126143 (URN)10.1093/ecco-jcc/jjv184 (DOI)000370275900010 ()26507858 (PubMedID)
Available from: 2016-03-15 Created: 2016-03-15 Last updated: 2018-03-21
Myrelid, P. & Oresland, T. (2015). A reappraisal of the ileo-rectal anastomosis in ulcerative colitis. Journal of Crohn's & Colitis, 9(6), 433-438
Open this publication in new window or tab >>A reappraisal of the ileo-rectal anastomosis in ulcerative colitis
2015 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 9, no 6, p. 433-438Article, review/survey (Refereed) Published
Abstract [en]

Colectomy is still frequently required in the care of ulcerative colitis. The most common indications are either non-responding colitis in the emergency setting, chronic active disease, steroid-dependent disease or neoplastic change like dysplasia or cancer. The use of the ileal pouch anal anastomosis has internationally been the gold standard, substituting the rectum with a pouch. Recently the use of the ileorectal anastomosis has increased in frequency as reconstructive method after subtotal colectomy. Data from centres using ileorectal anastomosis have shown the method to be safe, with functionality and risk of failure comparable to the ileal pouch anal anastomosis. The methods have different advantages as well as disadvantages, depending on a number of patient factors and where in life the patient is at time of reconstruction. The ileorectal anastomosis could, together with the Kock continent ileostomy, in selected cases be a complement to the ileal pouch anal anastomosis in ulcerative colitis and should be discussed with the patient before deciding on reconstructive method.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy C - Option B, 2015
Keywords
Subtotal colectomy; ulcerative colitis; surgery; reconstruction; ileorectal anastomosis; ileal pouch anal anastomosis
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120171 (URN)10.1093/ecco-jcc/jjv060 (DOI)000356617900001 ()25863275 (PubMedID)
Available from: 2015-07-13 Created: 2015-07-13 Last updated: 2017-12-04
Myrelid, P. (2015). Editorial Material: One step ahead in the care of Crohns disease in COLORECTAL DISEASE, vol 17, issue 4, pp 277-278. Colorectal Disease, 17(4), 277-278
Open this publication in new window or tab >>Editorial Material: One step ahead in the care of Crohns disease in COLORECTAL DISEASE, vol 17, issue 4, pp 277-278
2015 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 17, no 4, p. 277-278Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117206 (URN)10.1111/codi.12916 (DOI)000351631800004 ()25800070 (PubMedID)
Available from: 2015-04-23 Created: 2015-04-21 Last updated: 2017-12-04
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7518-9213

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