The Metabolic Consequences of Surgery in Crohn's Disease

Abstract

In 124 patients with Crohn's disease, body weight, blood hemoglobin, ESR, serum iron, total iron-binding capacity (TIBC) and vitamin B₁₂ as well as serum and blood folate concentrations were determined at admission to hospital for primary surgery and at predetermined intervals during a 2-year postoperative follow-up period. Comparisons were made between 69 patients with ileal or predominantly ileal (IPI) and 55 patients with colonic or predominantly colonic disease (CPC). At admission the two groups of patients showed significant differences in several parameters. Anemia was twice as common in the CPC-group (80%) and hypoalbuminemia three times as common (85%). Abnormally low serum iron occurred with the same frequency (80%) in both groups, but the TIBC was more often reduced in the CPC-group (40%) compared to the IPI-group (6%). Increased ESR was found in all patients in the CPC-group and was also common in the IPI-group (60%). Although weight loss was common in both groups, its magnitude was twice as great in the CPC-group. Although low normal values of serum vitamin B₁₂ and folate in serum and red cells were common, only a few patients had concentrations below the normal reference limit. Except for ESR and serum iron, which were abnormal in 20% and 30% respectively, most of the variables studied were normal 6 months after operation (when effects related to substitution therapy or operative trauma could be excluded) and remained so during the rest of the follow-up period. As a rule, hematological indices and body weight became normal in patients free from recurrent disease, irrespective of whether they were operated upon for IPI- or CPC-disease. It is concluded that the impact of the disease on the nutritional status appears to be pronounced in both series of patients. The broad spectrum of disorders observed in ileal disease is qualitatively similar to that in colonic disease. The systemic effects of the inflammation account for most of the disorders and malabsorption is in this respect mostly over-emphasized.

Key words:

• Blood chemistry
• body weight
• Crohn's disease
• nutritional status
• postoperative course
• surgical treatment