SpringerLink
Log in

Ileocecal valve that cannot be intubated in Crohn’s disease: is this a sign of poor prognosis?

  • RESEARCH
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

In Crohn’s disease (CD), the inability to intubate the ileocecal valve during colonoscopy may be associated with a poor disease prognosis. In this study, we aimed to compare the long-term outcomes of CD patients with and without ileocecal valve intubation during colonoscopy to assess its value as a prognostic parameter.

Methods

This retrospective study involved CD patients with isolated ileal involvement who underwent colonoscopy between 1993 and 2022. We compared the basic characteristics and long-term clinical outcomes of two groups of patients: those with intubated and non-intubated ileocecal valves during colonoscopy.

Results

Of the 155 participants, 97 (62.5%) patients’ ileum could be intubated and 58 (37.5%) could not be intubated. The non-intubated group was younger at diagnosis (39 years versus 30.5 years, p = 0.002), but other baseline characteristics such as sex, smoking status, disease duration, perianal disease, and upper gastrointestinal involvements were similar. The non-intubated group had higher rates of steroid dependence (67.2% versus 46.4%; p = 0.012), biologic treatment (89.7% versus 58.8%; p < 0.001), CD-related hospitalization (81% versus 24.7%; p < 0.001), and major abdominal surgery (58.6% versus 15.5%; p < 0.001). In the logistic regression analysis, the positive predictors of successful ileum intubation were inflammatory type CD (OR: 14.821), high serum albumin level (OR: 5.919), and older age (OR: 1.069), while the negative predictors were stenosing (OR: 0.262) and penetrating (OR: 0.247) CD behavior.

Conclusions

In Crohn’s disease patients with isolated ileal involvement, ileocecal valve cannot be intubated during colonoscopy may indicate the severity of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

  1. Freeman HJ (2014) Natural history and long-term clinical course of Crohn’s disease. World J Gastroenterol 20(1):31–36

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gajendran M et al (2018) A comprehensive review and update on Crohn’s disease. Dis Mon 64(2):20–57

    Article  PubMed  Google Scholar 

  3. Cosnes J et al (2002) Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 8(4):244–250

    Article  PubMed  Google Scholar 

  4. Cosnes J et al (2011) Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140(6):1785–1794

    Article  PubMed  Google Scholar 

  5. Narula N et al (2021) Outcomes of passable and non-passable strictures in clinical trials of Crohn’s disease: a post-hoc analysis. J Crohns Colitis 15(10):1649–1657

    Article  PubMed  Google Scholar 

  6. Wynn TA (2008) Cellular and molecular mechanisms of fibrosis. J Pathol 214(2):199–210

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Chang CW et al (2015) Intestinal stricture in Crohn’s disease. Intest Res 13(1):19–26

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sulz MC et al (2020) Treatment algorithms for Crohn’s disease. Digestion 101(Suppl 1):43–57

    Article  CAS  PubMed  Google Scholar 

  9. Feuerstein JD et al (2021) AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn’s disease. Gastroenterology 160(7):2496–2508

    Article  PubMed  Google Scholar 

  10. Lichtenstein GR et al (2018) ACG clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol 113(4):481–517

    Article  PubMed  Google Scholar 

  11. Adamina M et al (2020) ECCO guidelines on therapeutics in Crohn’s disease: surgical treatment. J Crohns Colitis 14(2):155–168

    Article  PubMed  Google Scholar 

  12. Mowat C et al (2011) Guidelines for the management of inflammatory bowel disease in adults. Gut 60(5):571–607

    Article  PubMed  Google Scholar 

  13. Patel KV et al (2016) Patient optimization for surgery relating to Crohn’s disease. Nat Rev Gastroenterol Hepatol 13(12):707–719

    Article  PubMed  Google Scholar 

  14. Berg DR, Colombel JF, Ungaro R (2019) The role of early biologic therapy in inflammatory bowel disease. Inflamm Bowel Dis 25(12):1896–1905

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ghazi LJ et al (2013) Step up versus early biologic therapy for Crohn’s disease in clinical practice. Inflamm Bowel Dis 19(7):1397–1403

    Article  PubMed  Google Scholar 

  16. Herrlinger K, Stange EF (2010) Treatment of Crohn’s disease: step-up or top-down? Dtsch Med Wochenschr 135(34–35):1694–1698

    Article  CAS  PubMed  Google Scholar 

  17. Piotrowska M et al (2020) [Strategies in Crohn’s disease treatment - “step-up” vs. “top-down”]. Postepy Biochem 65(4):313–317

  18. Rogler G (2013) Top-down or step-up treatment in Crohn’s disease? Dig Dis 31(1):83–90

    Article  PubMed  Google Scholar 

  19. Tsui JJ, Huynh HQ (2018) Is top-down therapy a more effective alternative to conventional step-up therapy for Crohn’s disease? Ann Gastroenterol 31(4):413–424

    PubMed  PubMed Central  Google Scholar 

  20. Liverani E et al (2016) How to predict clinical relapse in inflammatory bowel disease patients. World J Gastroenterol 22(3):1017–1033

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Zallot C, Peyrin-Biroulet L (2012) Clinical risk factors for complicated disease: how reliable are they? Dig Dis 30(Suppl 3):67–72

    Article  PubMed  Google Scholar 

  22. D’Haens GR et al (2009) Endpoints for clinical trials evaluating disease modification and structural damage in adults with Crohn’s disease. Inflamm Bowel Dis 15(10):1599–1604

    Article  PubMed  Google Scholar 

  23. Dotan I (2009) Disease behavior in adult patients: are there predictors for stricture or fistula formation? Dig Dis 27(3):206–211

    Article  PubMed  Google Scholar 

  24. Benevento G et al (2010) Diagnosis and assessment of Crohn’s disease: the present and the future. Expert Rev Gastroenterol Hepatol 4(6):757–766

    Article  PubMed  Google Scholar 

  25. Gomollon F et al (2017) 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis 11(1):3–25

    Article  PubMed  Google Scholar 

  26. Rieder F et al (2016) European Crohn’s and Colitis Organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn’s disease. J Crohns Colitis 10(8):873–885

    Article  PubMed  Google Scholar 

  27. Peyrin-Biroulet L (2008) Is ileocaecal Crohn’s disease L1 or L3 according to the Montreal classification? Gut 57(3):427

    Article  PubMed  Google Scholar 

  28. Annese V et al (2013) European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 7(12):982–1018

    Article  PubMed  Google Scholar 

  29. Satsangi J et al (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55(6):749–753

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bernell O, Lapidus A, Hellers G (2000) Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg 231(1):38–45

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Beaugerie L et al (2006) Predictors of Crohn’s disease. Gastroenterology 130(3):650–656

    Article  PubMed  Google Scholar 

  32. Dranga M et al (2021) Anemia in Crohn’s disease-the unseen face of inflammatory bowel disease. Medicina (Kaunas)  57(10)

  33. Sostegni R et al (2003) Review article: Crohn’s disease: monitoring disease activity. Aliment Pharmacol Ther 17(Suppl 2):11–17

    Article  PubMed  Google Scholar 

  34. Fantodji C et al (2022) Appendectomy and risk for inflammatory bowel disease: effect of age and time post appendectomy - a cohort study. BMJ Open Gastroenterol 9(1)

  35. Kaplan GG et al (2008) The risk of develo** Crohn’s disease after an appendectomy: a meta-analysis. Am J Gastroenterol 103(11):2925–2931

    Article  PubMed  Google Scholar 

  36. Piovani D et al (2019) Environmental risk factors for inflammatory bowel diseases: an umbrella review of meta-analyses. Gastroenterology 157(3):647–659e4

  37. Chen D et al (2019) Prior appendectomy and the onset and course of Crohn’s disease in Chinese patients. Gastroenterol Res Pract 2019:8463926

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800, Cankaya, Ankara, Turkey

    Muhammed Bahaddin Durak, Bayram İnan & Ilhami Yuksel

  2. Department of Gastroenterology, Health Sciences University, Mehmet, Akif Inan Training and Research Hospital, Sanliurfa, Turkey

    Cem Simsek

  3. Department of Gastroenterology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey

    Ilhami Yuksel

  4. Graduate School of Health Sciences, Hacettepe University, Ankara, Turkey

    Cem Simsek

Authors
  1. Muhammed Bahaddin Durak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cem Simsek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bayram İnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilhami Yuksel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Muhammed Bahaddin Durak: investigation, data collection, writing—orginial draft preparation, reviewing and editing, visualization. Cem Simsek: writing—orginial draft preparation, reviewing and editing. Ilhami Yuksel: conceptualization, methodology, investigation, supervision, writing—reviewing and editing.

Corresponding author

Correspondence to Muhammed Bahaddin Durak.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Durak, M.B., Simsek, C., İnan, B. et al. Ileocecal valve that cannot be intubated in Crohn’s disease: is this a sign of poor prognosis?. Int J Colorectal Dis 38, 103 (2023). https://doi.org/10.1007/s00384-023-04401-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00384-023-04401-0

Keywords

Search

Navigation