Marko Brinar

Background: Crohn’s disease complicated by intra-abdominal abscesses often requires surgery. Percutaneous drainage may prevent surgery, but optimal post-drainage management is unclear. We aimed to analyze the long-term outcomes of Crohn’s disease with intra-abdominal abscesses after intervention. Methods: Patients with penetrating Crohn’s disease and a single intra-abdominal abscess were enrolled in this multicenter, international, retrospective study after the detection of the abscess (baseline), with a minimum follow-up of 12 months. Those requiring urgent bowel resection were excluded. Patients were grouped by elective surgical need after successful (catheter insertion with effective drainage) percutaneous drainage (controls: no pre-resection drainage). The primary outcome was abscess recurrence. We also assessed stoma rate, post-procedural complications, hospitalizations, advanced treatment need, postoperative luminal recurrence, and need for re-drainage. Results: We studied 157 patients with Crohn’s disease (9 countries; males: 58%, median age: 32.4 [interquartile range: 25–39 years]); 89/157 underwent percutaneous drainage (median follow-up: 95.9 weeks [interquartile range: 58–104]). Abscess recurrence did not differ by drainage (p = 0.221). Abscess size was associated with advanced-treatment initiation (Odds ratio: 0.978; 95% confidence interval: 0.960–0.997, p = 0.023) and postoperative luminal recurrence (Odds ratio: 1.044, 95% confidence interval: 1.012–1.078, p = 0.007). Time to resection was longer after drainage, and ROC analysis raised predictive value for re-drainage (16.6 weeks post-drainage; AUC = 0.82, 95% confidence interval: 0.73–0.92). Patients without drainage had more post-procedural complications. Conclusions: Abscess size should guide management. Delayed resection may increase re-drainage odds, whereas surgery alone may have higher complication rates. Percutaneous drainage can safely postpone resection.

Chronic inflammation in inflammatory bowel disease (IBD) triggers significant extracellular matrix remodeling, including elastin remodeling, leading to severe clinical complications. Novel methods to assess intestinal tissue destruction may act as surrogate markers of endoscopic disease activity, relieving patients of invasive endoscopy. We explored the noninvasive blood-based biomarkers ELP-3 and ELM-12, measuring elastin degradation in IBD. In a study involving 104 Crohn’s disease (CD), 39 ulcerative colitis (UC), and 29 healthy donors, we assessed these biomarkers’ association with endoscopic and clinical disease activity using ELISA. Patients were evaluated based on the SES-CD and CDAI for CD patients and modified MES and partial Mayo for UC patients. ELP-3 and ELM-12 were elevated in patients with IBD. Discerning CD patients in endoscopic remission and mild from moderate to severe, ELP-3 provided an AUC of 0.69 and ELM-12 an AUC of 0.73. The ELP-3 biomarker was associated with UC patients and provided the highest diagnostic power of 0.87 for remission vs. active clinical disease. The data suggest an association of ELP-3 with active CD and ELM-12 with endoscopic remission in CD patients. Additionally, ELP-3 could identify UC patients with active clinical disease from patients in remission. The noninvasive biomarkers ELP-3 and ELM-12 could be potential surrogate biomarkers of elastin degradation and endoscopic and clinical disease markers.

Extracellular matrix (ECM) homeostasis is highly affected in active inflammatory bowel disease (IBD). The aim of the study was to investigate serological biomarkers of type III, IV, and V collagen degradation and formation, and their association with disease activity in IBD. ECM remodeling serum biomarkers were measured in 162 IBD patients, 110 with Crohn’s disease (CD) and 52 with ulcerative colitis (UC), and in 29 healthy donors. Biomarkers of type III collagen degradation (C3M) and formation (PRO-C3), type IV collagen degradation (C4M) and formation (PRO-C4), and type V collagen formation (PRO-C5) were measured using ELISA. Inflammatory activity was assessed using endoscopic, clinical, and biochemical activity indices. The highest diagnostic value was identified in discriminating endoscopically moderate to severe disease in CD (PRO-C3, C3M/PRO-C3, and C4M with AUC of 0.70, 0.73, and 0.69, respectively) and UC (C3M, C3M/PRO-C3, and C4M with AUC of 0.86, 0.80, and 0.76, respectively). C4M and C3M/PRO-C3 in combination yielded AUC of 0.93 (0.66–0.90) in CD and 0.94 (0.65–0.99) in UC. This study confirmed that ECM remodeling reflected disease activity in CD and UC. A combination of C4M, C3M, and PRO-C3 biomarkers may potentially be considered as a biomarker differentiating moderate to severe endoscopic disease.