C Madre et al. JPGN 2021; 73: 333-337. A European Survey on Digestive Perianastomotic Ulcerations, a Rare Crohn-like Disorder Occurring in Children and Young Adults
This survey study with 51 children described the etiology and treatment of perianastomic ulcerations (PAU).
- Most common initial etiologies: necrotizing enterocolitis (n = 20) or Hirschsprung disease (n = 11)
- Median onset of symptoms: 39 [22–106] months after surgery
- Clinical features: Anemia was the most prevalent symptom followed by diarrhea, abdominal pain, bloating, and failure to thrive. Hypoalbuminemia, elevated CRP, and fecal calprotectin were common
- Deep ulcerations were found in 59% of patients usually proximally to the anastomosis (68%)
- Treatments: treatments reported to be the most effective included exclusive enteral nutrition (31/35, 88%), redo anastomosis (18/22, 82%), and alternate antibiotic treatment (37/64, 58%). The authors note that despite similarity to Crohn’s disease, there was a lack of response to immunosuppressors and anti-TNF therapies
Related article: H Barraclough et al. JPGN 2021; 73: 329-332. Anastomotic Ulcers: A Tertiary Centre Experience of Endoscopic Management Techniques This study summarized a tertiary care center experience with 9 patients (2 with IBD). Frequent treatment included aminosalicylates, and endoscopic treatments (APC, endoclips).
Related blog posts:
- Identifying Anasomotic Ulcers with Capsule Endoscopy
- Crohn’s Disease Anastomotic Ulcers (usually represent disease progression)