New surgical approach has ‘significant impact’ on treatment of Crohn’s disease

A surgical approach pioneered in Ireland could have a global impact on the treatment of Crohn’s disease.

A new international study published in the leading journal Gastroenterology has shown that the approach first developed in University of Limerick (UL) and University Hospital Limerick (UHL) in Ireland by Professor of Surgery J Calvin Coffey and his research team, could have a major impact on treating Crohn’s disease.

Crohn’s disease is incurable, with high rates of recurrence, even after surgery. It is a condition for which at least 80% of patients will require surgery to treat at some point. 

To add to this, around 40% of those will require repeat surgery.

However, the new approach pioneered at UL and UHL dramatically reduces the possibility that follow-up surgery will be needed to as few as approximately 4% of patients.

The new surgical approach requires removal of the mesentery – which was reclassified as a new organ following discoveries by Professor Coffey’s team and collaborators in 2016. It builds on the scientific advances the group made on the mesentery, an organ in which all digestive organs of the abdomen develop and then remain connected to.

An international trial, just published in Gastroenterology, has validated the approach used by Professor Coffey and colleagues which could be very significant for treating Crohn’s disease.

“Crohn’s disease has a terrible impact on patient’s lives,” said Professor Coffey, who is Foundation Chair of Surgery at UL’s School of Medicine and Consultant General and Colorectal Surgeon at UHL.

“Surgery is required as often as it is because the medical treatments used against Crohn’s disease cannot stop progression of the disease in most patients. This is despite nearly a century of intensive research in this field.”

Using the advances made in our understanding of the mesentery however, the new surgical approach removes the mesentery, which adjoins the diseased intestine.

“Prior to this technique, the convention among surgeons was to leave the mesentery in part because removing it is technically challenging. The safe removal of the mesentery in Crohn’s disease was helped by the advances made in our understanding of the mesentery at UHL and UL,” explained Professor Coffey.

“The results of this trial are clear evidence of the direct impact the discoveries on the mesentery have had in the clinical and scientific setting.”

The new study shows that removal of the mesentery reduces recurrence of Crohn's disease in the inner lining of the intestine - called endoscopic recurrence.

The results of the trial, led by international collaborators including Dr Yi Li of Nanjing University in China, is an independent, high-level validation of the surgical approach first developed in Limerick.

The research looked at relapse of Crohn's disease in the inner lining of the intestine, which generally occurs very quickly after initial surgery for the disease.

The randomised control trial found that patients who had conventional surgery tended to suffer high rates of relapse, but that patients who had surgery performed using the new approach, had lower relapse rates – from around 46% down to just 23% of patients.

The trial also looked at the severity of relapse in the inner lining and found that for each grade of severity, relapse was reduced in patients in whom the mesentery was also removed.

The results indicate strong support for including removal of the mesentery during surgery for Crohn’s disease.

“The results mean the approach developed in Limerick could become standard practice in the management of patients with Crohn’s disease,” said Professor Coffey.

“This could in turn have very positive benefits for patients with Crohn’s disease.

“These patients are generally young. They are most affected by the disease just at that time when they are embarking on new careers, buying houses, getting married and starting families. As a result of the disease, they are committed to an awful reality during this very important time.

“These patients often require repeated admissions to hospital and sometimes they are very ill. Ultimately, they then must undergo surgery. This has remained the case despite almost a century of investigating potential medical or pharmaceutical means of stopping the disease developing or advancing.

“This study is further support for the fact that surgery in which the mesentery is removed reduces the need for readmissions, repeated medications and the requirement for reoperation in patients with Crohn’s disease. So this is very positive news indeed for patients with Crohn’s disease and for their families,” Professor Coffey added.

ENDS

The study, ‘Postoperative Endoscopic Outcomes in the MESOCOLIC Trial Investigating Mesenteric-Based Surgery for Crohn's Disease’, by John Calvin Coffey and others, has been published by the journal Gastroenterology.

For further information, please contact:

Alan Owens

Communications Manager

University of Limerick

alan.owens@ul.ie

About University of Limerick:

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