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MICI: prise en charge du patient opéré

IBD: Management of operated patients

  • Mise Au Point
  • Published:
Acta Endoscopica

Résumé

La prévention de la récidive post-opératoire au cours des MICI est un problème complexe, mais fréquent. Le risque de résection intestinale au cours de la maladie de Crohn dans une étude en population incluant 314 patients avec un suivi médian de 13,2 ans était évalué à 49% et 64% respectivement à 10 et 30 ans après le diagnostic [1]. Si la chirurgie permet généralement de passer un cap, elle ne permet pas de contrôler l’évolutivité de la maladie. Au cours de la rectocolite hémorragique, le risque de colectomie dans une étude en population incluant 368 patients avec un suivi médian de 15,1 ans était évalué à 16% et 28% respectivement à 10 et 30 ans après le diagnostic [1]. Il était classique de considérer que la chirurgie permettait de «guérir» la rectocolite hémorragique. Ce concept est largement remis en cause en raison du risque élevé de pochite chronique après coloproctectomie et anastomose iléoanale, et du risque de persistance de la maladie sur le rectum après colectomie totale et anastomose iléorectale, intervention de plus en plus souvent pratiquée au cours de d’activité génitale étant donné le risque d’hypofertilité après anastomose iléoanale [2].

La prise en charge postopératoire implique de connaître les facteurs favorisant la récidive, d’en évaluer les conséquences et de les mettre en balance avec les avantages et inconvénients d’un traitement préventif. Etant donné les particularités propres à la maladie de Crohn et à la rectocolite hémorragique, ces 2 situations seront développées séparément. Seuls les traitements préventifs de la récidive postopératoire seront abordés; les traitements curatifs une fois la rechute confirmée, ne diffèrent pas des traitements classiques des MICI.

Abstract

The prevention of post-operative relapse in IBD is a complex but common problem. The risk for intestinal resection in Crohn’s disease at 10 and 30 years post-diagnosis in a population study including 314 patients with a median follow-up of 13.2 years was 49% and 64%, respectively [1]. Even though surgery allows for going a step further, it does not prevent the disease from evolving. In ulcerative colitis, the risk for colectomy at 10 and 30 years post-diagnosis in a population study including 368 patients with a median follow-up of 15.1 years was 16% and 28%, respectively [1]. It was commonly believed that surgery could “cure” ulcerative colitis. This concept is now largely challenged because of the elevated risk for chronic pouchitis after coloproctectomy and ileoanal anastomosis and because of the risk for persisting disease in the rectum following total colectomy and ileorectal anastomosis, an operation performed more and more often for ulcerative colitis in women of childbearing age, given the risk for hypofertility after ileoanal anastomosis [2].

Good post-operative management requires knowing the factors favouring relapse, evaluating their consequences and being able to balance them with the benefits and disadvantages of preventive treatment. Given the specificities of Crohn disease versus ulcerative colitis, the two diseases will be separately reviewed. Only the preventive treatments for post-operative relapse will be discussed since curative treatments, once relapse is confirmed, do not differ from the classical IBD treatments.

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Références

  1. Dhillon S, et al. Am J Gastroenterol 2005;100:S303.

    Google Scholar 

  2. Gambiez L, Cosnes J, Guedon C, Karoui M, Sielezneff I, Zerbib P, Panis Y. [Post operative care]. Gastroenterol Clin Biol 2004;28:1005–30.

    PubMed  Google Scholar 

  3. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990;99:956–63.

    PubMed  CAS  Google Scholar 

  4. Rutgeerts P, Van Assche G, Vermeire S, D’Haens G, Baert F, Noman M, Aerden I, De Hertogh G, Geboes K, Hiele M, D’Hoore A, Penninckx F. Ornidazole for prophylaxis of postoperative Crohn’s disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2005;128:856–61.

    Article  PubMed  CAS  Google Scholar 

  5. Sandborn WJ, Feagan BG, Hanauer SB, Lochs H, Lofberg R, Modigliani R, Present DH, Rutgeerts P, Scholmerich J, Stange EF, Sutherland LR. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology 2002;122:512–30.

    Article  PubMed  Google Scholar 

  6. Bourreille A, Jarry M, D’Halluin PN, Ben-Soussan E, Maunoury V, Bulois P, Sacher-Huvelin S, Vahedy K, Lerebours E, Heresbach D, Bretagne JF, Colombel JF, Galmiche JP. Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn’s disease: a prospective study. Gut 2006;55:978–83.

    Article  PubMed  CAS  Google Scholar 

  7. Cosnes J, Carbonnel F, Beaugerie L, Le Quintrec Y, Gendre JP. Effects of cigarette smoking on the long-term course of Crohn’s disease. Gastroenterology 1996;110:424–31.

    Article  PubMed  CAS  Google Scholar 

  8. Sutherland LR, Ramcharan S, Bryant H, Fick G. Effect of cigarette smoking on recurrence of Crohn’s disease. Gastroenterology 1990;98:1123–8.

    PubMed  CAS  Google Scholar 

  9. Cosnes J, Nion-Larmurier I, Afchain P, Beaugerie L, Gendre JP. Gender differences in the response of colitis to smoking. Clin Gastroenterol Hepatol 2004;2:41–8.

    Article  PubMed  Google Scholar 

  10. Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn’s disease: an intervention study. Gastroenterology 2001;120:1093–9.

    Article  PubMed  CAS  Google Scholar 

  11. Ryan WR, Allan RN, Yamamoto T, Keighley MR. Crohn’s disease patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg 2004;187:219–25.

    Article  PubMed  Google Scholar 

  12. Alvarez-Lobos M, Arostegui JI, Sans M, Tassies D, Plaza S, Delgado S, Lacy AM, Pique JM, Yague J, Panes J. Crohn’s disease patients carrying Nod2/CARD15 gene variants have an increased and early need for first surgery due to stricturing disease and higher rate of surgical recurrence. Ann Surg 2005;242:693–700.

    Article  PubMed  Google Scholar 

  13. Lautenbach E, Berlin JA, Lichtenstein GR. Risk factors for early postoperative recurrence of Crohn’s disease. Gastroenterology 1998;115:259–67.

    Article  PubMed  CAS  Google Scholar 

  14. Post S, Herfarth C, Bohm E, Timmermanns G, Schumacher H, Schurmann G, Golling M. The impact of disease pattern, surgical management, and individual surgeons on the risk for relaparotomy for recurrent Crohn’s disease. Ann Surg 1996;223:253–60.

    Article  PubMed  CAS  Google Scholar 

  15. Softley A, Myren J, Clamp SE, Bouchier IA, Watkinson G, de Dombal FT. Factors affecting recurrence after surgery for Crohn’s disease. Scand J Gastroenterol Suppl 1988;144:31–4.

    PubMed  CAS  Google Scholar 

  16. Tersigni R, Alessandroni L, Barreca M, Piovanello P, Prantera C. Does stapled functional end-to-end anastomosis affect recurrence of Crohn’s disease after ileocolonic resection? Hepatogastroenterology 2003;501422–5.

    PubMed  Google Scholar 

  17. Munoz-Juarez M, Yamamoto T, Wolff BG, Keighley MR. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum 2001;44:20–5; discussion 25–6.

    Article  PubMed  CAS  Google Scholar 

  18. Anseline PF, Wlodarczyk J, Murugasu R. Presence of granulomas is associated with recurrence after surgery for Crohn;s disease: experience of a surgical unit. Br J Surg 1997;84:78–82.

    Article  PubMed  CAS  Google Scholar 

  19. Wolfson DM, Sachar DB, Cohen A, Goldberg J, Styczynski R, Greenstein AJ, Gelernt IM, Janowitz HD. Granulomas do not affect postoperative recurrence rates in Crohn’s disease. Gastroenterology 1982;83:405–9.

    PubMed  CAS  Google Scholar 

  20. Wolff BG. Factors determining recurrence following surgery for Crohn’s disease. World J Surg 1998;22:364–9.

    Article  PubMed  CAS  Google Scholar 

  21. Fazio VW, Marchetti F, Church M, Goldblum JR, Lavery C, Hull TL, Milsom JW, Strong SA, Oakley JR, Secic M. Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg 1996;224:563–71; discussion 571–3.

    Article  PubMed  CAS  Google Scholar 

  22. Ferrante M, de Hertogh G, Hlavaty T, D’Haens G, Penninckx F, D’Hoore A, Vermeire S, Rutgeerts P, Geboes K, van Assche G. The value of myenteric plexitis to predict early postoperative Crohn’s disease recurrence. Gastroenterology 2006;130: 1595–606.

    Article  PubMed  Google Scholar 

  23. Steinhart AH, Ewe K, Griffiths AM, Modigliani R, Thomsen OO. Corticosteroids for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev 2003:CD000301.

  24. Papi C, Luchetti R, Gili L, Montanti S, Koch M, Capurso L. Budesonide in the treatment of Crohn’s disease: a metanalysis. Aliment Pharmacol Ther 2000;14:1419–28.

    Article  PubMed  CAS  Google Scholar 

  25. Camma C, Giunta M, Rosselli M, Cottone M. Mesalamine in the maintenance treatment of Crohn’s disease: a meta-analysis adjusted for confounding variables. Gastroenterology 1997;113:1465–73.

    Article  PubMed  CAS  Google Scholar 

  26. Cottone M, Camma C. Mesalamine and relapse prevention in Crohn’s disease. Gastroenterology 2000;119:597.

    PubMed  CAS  Google Scholar 

  27. Rutgeerts P, Hiele M, Geboes K, Peeters M, Penninckx F, Aerts R, Kerremans R. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology 1995;108:1617–21.

    Article  PubMed  CAS  Google Scholar 

  28. Hanauer SB, Korelitz BI, Rutgeerts P, Peppercorn MA, Thisted RA, Cohen RD, Present DH. Postoperative maintenance of Crohn’s disease remission with 6-mercaptopurine, mesalamine, or placebo: a 2-year trial. Gastroenterology 2004;127:723–9.

    Article  PubMed  CAS  Google Scholar 

  29. Ardizzone S, Maconi G, Sampietro GM, Russo A, Radice E, Colombo E, Imbesi V, Molteni M, Danelli PG, Taschieri AM, Bianchi Porro G. Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn’s disease. Gastroenterology 2004;127:730–40.

    Article  PubMed  CAS  Google Scholar 

  30. Alves A, Panis Y, Joly F, Pocard M, Lavergne-Slove A, Bouhnik Y, Valleur P. Could immunosuppressive drugs reduce recurrence rate after second resection for Crohn disease? Inflamm Bowel Dis 2004;10:491–5.

    Article  PubMed  Google Scholar 

  31. Campieri M, Rizzello F, A AV, et al. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of post-operative recurrence of Crohn’s disease: a randomised controlled study vs mesalamine Gastroenterology 2000;118:A4179.

    Article  Google Scholar 

  32. Prantera C, Scribano ML, Falasco G, Andreoli A, Luzi C. Ineffectiveness of probiotics in preventing recurrence after curative resection for Crohn’s disease: a randomised controlled trial with Lactobacillus GG. Gut 2002;51:405–9.

    Article  PubMed  CAS  Google Scholar 

  33. Marteau P, Lemann M, Seksik P, Laharie D, Colombel JF, Bouhnik Y, Cadiot G, Soule JC, Bourreille A, Metman E, Lerebours E, Carbonnel F, Dupas JL, Veyrac M, Coffin B, Moreau J, Abitbol V, Blum-Sperisen S, Mary JY. Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of post-operative recurrence in Crohn’s disease: a randomised, double blind, placebo controlled GETAID trial. Gut 2006;55:842–7.

    Article  PubMed  CAS  Google Scholar 

  34. Van Gossum A, Dewit O, Louis E, de Hertogh G, Baert F, Fontaine F, DeVos M, Enslen M, Paintin M, Franchimont D. Multicenter randomized-controlled clinical trial of probiotics (Lactobacillus johnsonii, LA1) on early endoscopic recurrence of Crohn’s disease after Ileo-caecal resection. Inflamm Bowel Dis 2007;13:135–42.

    Article  PubMed  Google Scholar 

  35. Sorrentino D, Terrosu G, Avellini C, Maiero S. Infliximab with low-dose methotrexate for prevention of postsurgical recurrence of ileocolonic Crohn disease. Arch Intern Med 2007;167:1804–7.

    Article  PubMed  Google Scholar 

  36. Belluzzi A, Campieri M, Belloli C. A new enteric-coated preparation preparation of omega3 fatty acids for preventing post-surgical recurrence in Crohn’s disease. Gastroenterology 1997;112:A930.

    Google Scholar 

  37. Colombel JF, Rutgeerts P, Malchow H, Jacyna M, Nielsen OH, Rask-Madsen J, Van Deventer S, Ferguson A, Desreumaux P, Forbes A, Geboes K, Melani L, Cohard M. Interleukin 10 (Tenovil) in the prevention of postoperative recurrence of Crohn’s disease. Gut 2001;49:42–6.

    Article  PubMed  CAS  Google Scholar 

  38. Travis SP, Stange EF, Lemann M, Oresland T, Chowers Y, Forbes A, D’Haens G, Kitis G, Cortot A, Prantera C, Marteau P, Colombel JF, Gionchetti P, Bouhnik Y, Tiret E, Kroesen J, Starlinger M, Mortensen NJ. European evidence based consensus on the diagnosis and management of Crohn’s disease: current management. Gut 2006;55 Suppl 1:116–35.

    Google Scholar 

  39. Fazio VW, Tjandra JJ, Lavery IC, Church JM, Milsom JW, Oakley JR. Long-term follow-up of strictureplasty in Crohn’s disease. Dis Colon Rectum 1993;36:355–61.

    Article  PubMed  CAS  Google Scholar 

  40. Stebbing JF, Jewell DP, Kettlewell MG, Mortensen NJ. Recurrence and reoperation after strictureplasty for obstructive Crohn’s disease: long-term results [corrected]. Br J Surg 1995;82:1471–4.

    Article  PubMed  CAS  Google Scholar 

  41. Tekkis PP, Purkayastha S, Lanitis S, Athanasiou T, Heriot AG, Orchard TR, Nicholls RJ, Darzi AW. A comparison of segmental vs subtotal/total colectomy for colonic Crohn’s disease: a meta-analysis. Colorectal Dis 2006;8:82–90.

    Article  PubMed  CAS  Google Scholar 

  42. Bernell O, Lapidus A, Hellers G. Recurrence after colectomy in Crohn’s colitis. Dis Colon Rectum 2001;44:647–54; discussion 654.

    Article  PubMed  CAS  Google Scholar 

  43. Cattan P, Bonhomme N, Panis Y, Lemann M, Coffin B, Bouhnik Y, Allez M, Sarfati E, Valleur P. Fate of the rectum in patients undergoing total colectomy for Crohn’s disease. Br J Surg 2002;89:454–9.

    Article  PubMed  CAS  Google Scholar 

  44. Mahadevan U, Sandborn WJ. Diagnosis and management of pouchitis. Gastroenterology 2003;124:1636–50.

    Article  PubMed  Google Scholar 

  45. Fleshner P, Ippoliti A, Dubinsky M, Ognibene S, Vasiliauskas E, Chelly M, Mei L, Papadakis KA, Landers C, Targan S. A prospective multivariate analysis of clinical factors associated with pouchitis after ileal pouch-anal anastomosis. Clin Gastroenterol Hepatol 2007;5:952–8; quiz 887.

    Article  PubMed  Google Scholar 

  46. Gionchetti P, Rizzello F, Helwig U, Venturi A, Lammers KM, Brigidi P, Vitali B, Poggioli G, Miglioli M, Campieri M. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology 2003;124: 1202–9.

    Article  PubMed  Google Scholar 

  47. Gionchetti P, Rizzello F, Venturi A, Brigidi P, Matteuzzi D, Bazzocchi G, Poggioli G, Miglioli M, Campieri M. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 2000;119:305–9.

    Article  PubMed  CAS  Google Scholar 

  48. Mimura T, Rizzelo F, Helwig U, Poggioli G, Schreiber S, Talbot IC, Nicholls RJ, Gionchetti P, Campieri M, Kamm MA. Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut 2004;53:108–14.

    Article  PubMed  CAS  Google Scholar 

  49. Ording Olsen K, Juul S, Berndtsson I, Oresland T, Laurberg S. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002;122:15–9.

    Article  PubMed  Google Scholar 

  50. Baker WN, Glass RE, Ritchie JK, SO. A. Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis. Br J Surg 1978;65:862–8.

    Article  PubMed  CAS  Google Scholar 

  51. Johnson WR, McDermott FT, Hughes ES, Pihl EA, Milne BJ, Price AB. The risk of rectal carcinoma following colectomy in ulcerative colitis. Dis Colon Rectum 1983;26:44–6.

    Article  PubMed  CAS  Google Scholar 

  52. Oakley JR, Jagelman DG, Fazio VW, Lavery IC, Weakley FL, Easley K, Farmer RG. Complications and quality of life after ileorectal anastomosis for ulcerative colitis. Am J Surg 1985;149:23–30.

    Article  PubMed  CAS  Google Scholar 

  53. Navratil E, Stettler C, Paul G, Vilotte J, Vissuzaine C, Mignon M, Potet F. Assessment of dysplasia, mucosal mucins, p53 protein expression, and DNA content in ulcerative colitis patients with colectomy and ileorectal anastomosis. Scand J Gastroenterol 1995;30:361–6.

    Article  PubMed  CAS  Google Scholar 

  54. Beaugerie L, Penna C. Rectocolite hémorragique: anastamose iléo-rectale ou iléo-anale? Gastroenterol Clin Biol 2000;24:39–46.

    Google Scholar 

  55. Rodriguez SA, Collins JM, Knigge KL, Eisen GM. Surveillance and management of dysplasia in ulcerative colitis. Gastrointest Endosc 2007;65:432–9.

    PubMed  Google Scholar 

  56. Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, O’Morain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut 2006;55 Suppl 1:i36–58.

    Article  PubMed  Google Scholar 

  57. Rutgeerts P. Review article: recurrence of Crohn’s disease after surgery — the need for treatment of new lesions. Aliment Pharmacol Ther 2006;24 Suppl 3:29–32.

    Article  PubMed  Google Scholar 

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  1. Pôle des maladies de l’appareil digestif, hôpital Beaujon, 100, boulevard du Général Leclerc, F-92110, Clichy, France

    X. Treton, V. Setakhr, C. Stefanescu, A. Attar, Y. Panis & Y. Bouhnik

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  1. X. Treton
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  2. V. Setakhr
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  3. C. Stefanescu
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Correspondence to Y. Bouhnik.

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Treton, X., Setakhr, V., Stefanescu, C. et al. MICI: prise en charge du patient opéré. Acta Endosc 38, 375–386 (2008). https://doi.org/10.1007/s101900800019

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