Colonic Crohn’s disease – decision is more important than incision: A surgical dilemma

Table 1 Features of ileal/ileocolonic Crohn’s disease, isolated colonic Crohn’s disease, and ulcerative colitis

Characteristics	Ileal and ileocolonic CD	Isolated colonic CD	Ulcerative colitis
Sex	Slight female predominance (55%)	Female predominance (65%)	Equal or slight male predominance
Genetics	Crohn’s-associated genotype including NOD2/CARD15	Genotype midway between CD and UC	UC-associated genotype including HLA-DRB1*01:03
Serology	ASCA commonly positive; pANCA usually negative	ASCA less commonly positive than ileal CD; pANCA positive	ASCA usually negative; pANCA commonly positive
Mucosa-associated microbiota	Marked changes commonly including increased proteobacteria (e.g., E. coli) and fusobacteria	Intermediate changes similar to ileal/ileocolonic CD but less consistent	Modest changes, including slight increase in E. coli
Response to mesalazine	No efficacy	No efficacy	Good efficacy
Response to anti-TNF	Good efficacy	Good efficacy, probably better than for ileal/ileocolonic CD	Good efficacy
Response to exclusive enteral nutrition	Good efficacy	Probably good efficacy	No efficacy
Surgery rate and type	Required in majority	Required in minority. High failure for pouch-anal reconstruction	Required in minority. Low failure for pouch-anal reconstruction

CD: Crohn’s disease; ASCA: Anti-Saccharomyces cerevisiae; HLA: Human leucocyte antigen; pANCA: Perinuclear antineutrophil cytoplasmic antibodies; TNF: Tumor necrosis factor; UC: Ulcerative colitis.

Table 2 Recurrence after segmental bowel resection and after total colectomy in patients with isolated colonic Crohn’s disease

Ref.	Patient/type of surgery	Recurrence rate (%)
Longo et al[16], 1988	18 segmental bowel resection	62
	131 total colectomy	65
Allan et al[15], 1989	36 segmental bowel resection	66
	63 total colectomy	53
Bernell et al[18], 2001	134 segmental bowel resection	49
	106 total colectomy	53
Andersson et al[19], 2002	31 segmental bowel resection	39
	26 total colectomy	46
Martel et al[17], 2002	84 segmental bowel resection	43
	39 total colectomy	41
Fichera et al[13], 2005	55 segmental bowel resection	38.8
	49 total colectomy	22.9
	75 total proctocolectomy	9.3