Hopp til innhold
NHI.no
Annonse

Crohns sykdom, kirurgi: Stomi

Innhold i artikkelen

Noen pasienter som har Crohns sykdom i tykktarmen, må få fjernet hele eller deler av tykktarmen i en operasjon som betegnes kolektomi. I forbindelse med inngrepet føres den nedre delen av tynntarmen, ileum, gjennom bukveggen i nedre del av buken slik at tarmen munner på hudens overflate. Det er utført en ileostomi. Åpningen kalles et stoma, og avføring tømmer seg ut her. Stomaet er på størrelse med et kronestykke og plasseres vanligvis på nedre høyre side av buken nær beltelinjen. En pose festes over åpningen og samler opp avføring, og pasienten tømmer den ved behov. De aller fleste pasienter som har fått utført kolektomi, lever et normalt aktivt liv. Noen vil senere kunne få lagt inn tarmen ved at tynntarmen sys sammen med endetarmsåpningen (ileoanal anastomose).

Annonse

Det kan også være aktuelt å ha det man kaller en avlastende stomi en periode. Med dagens utvalg av medikamenter, kan man i noen tilfeller avlaste den syke delen av tarmen ved å anlegge en stomi ovenfor det syke partiet. Deretter kan man gi medikamenter som i noen tilfeller vil kunne slå tilbake betennelsen i tarmen før stomien legges tilbake, og man får en nesten normalt fungerende tarm igjen.

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Crohns sykdom . Referanselisten for dette dokumentet vises nedenfor

  1. Dolinger M, Torres J, Vermeire S. Crohn's disease. Lancet. 2024 Mar 23;403(10432):1177-1191. PMID: 38437854 PubMed
  2. Maaser C, Sturm A, Vavricka SR, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. Journal of Crohn's and Colitis, Volume 13, Issue 2, February 2019, Pages 144–164K. DOI: 10.1093/ecco-jcc/jjy113 DOI
  3. Lirhus SS, Høivik ML, Moum B, Anisdahl K, Melberg HO. Incidence and Prevalence of Inflammatory Bowel Disease in Norway and the Impact of Different Case Definitions: A Nationwide Registry Study. Clin Epidemiol. 2021 Apr 23;13:287-294. PMID: 33935519. PubMed
  4. Buer LCT, Moum BA. Inflammatorisk tarmsykdom – diagnostikk og behandling. Indremedisineren, publisert 10.08.2016. indremedisineren.no
  5. Veauthier B, Hornecker JR. Crohn's Disease: Diagnosis and Management. Am Fam Physician. 2018;98(11):661-669. PubMed
  6. Mosli M, Alawadhi S, Hasan F, Abou Rached A, Sanai F, Danese S. Incidence, Prevalence, and Clinical Epidemiology of Inflammatory Bowel Disease in the Arab World: A Systematic Review and Meta-Analysis. Inflamm Intest Dis. 2021 Sep 7;6(3):123-131. PMID: 34722642 PubMed
  7. Shah SC, Khalili H, Gower-Rousseau C, Olen O, Benchimol EI, Lynge E, Nielsen KR, Brassard P, Vutcovici M, Bitton A, Bernstein CN, Leddin D, Tamim H, Stefansson T, Loftus EV Jr, Moum B, Tang W, Ng SC, Gearry R, Sincic B, Bell S, Sands BE, Lakatos PL, Végh Z, Ott C, Kaplan GG, Burisch J, Colombel JF. Sex-Based Differences in Incidence of Inflammatory Bowel Diseases-Pooled Analysis of Population-Based Studies From Western Countries. Gastroenterology. 2018 Oct;155(4):1079-1089.e3. PMID: 29958857 PubMed
  8. Pierik M, De Hertogh G, Vermeire S, Van Assche G, Van Eyken P, Joossens S, Claessens G, Vlietinck R, Rutgeerts P, Geboes K. Epithelioid granulomas, pattern recognition receptors, and phenotypes of Crohn's disease. Gut. 2005 Feb;54(2):223-7. PMID: 15647186 PubMed
  9. Baig MMA, Irfan SA, Sumbal A, Sumbal R, Kumar S, Ahmad J, Gandrakota N, Qadar LT, Chaudhry MS, Feroz A, Warraich MS. Prevalence of Gallstones in Ulcerative Colitis and Crohn's Disease: A Systematic Review and Meta-Analysis. Cureus. 2022 Jun 20;14(6):e26121. PMID: 35875294 PubMed
  10. Halme L, Paavola-Sakki P, Turunen U, et. al. Family and twin studies in inflammatory bowel disease. World J Gastroenterol 2009; 12: 3668-72. PubMed
  11. Franke A et al. Genome-wide meta-analysis increases to 71 the number of confirmed Crohn's disease susceptibility loci. Nat Genet. 2010 Dec;42(12):1118-25. doi: 10.1038/ng.717. PMID: 21102463; PMCID: PMC3299551.
  12. Nguyen LH, Örtqvist AK, Cao Y, Simon TG, Roelstraete B, Song M, Joshi AD, Staller K, Chan AT, Khalili H, Olén O, Ludvigsson JF. Antibiotic use and the development of inflammatory bowel disease: a national case-control study in Sweden. Lancet Gastroenterol Hepatol. 2020 Nov;5(11):986-995. PMID: 32818437 PubMed
  13. Faye AS, Allin KH, Iversen AT, Agrawal M, Faith J, Colombel JF, Jess T. Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study. Gut. 2023 Apr;72(4):663-670. PMID: 36623926 PubMed
  14. Piovani D, Danese S, Peyrin-Biroulet L, Nikolopoulos GK, Lytras T, Bonovas S. Environmental Risk Factors for Inflammatory Bowel Diseases: An Umbrella Review of Meta-analyses. Gastroenterology. 2019 Sep;157(3):647-659.e4. PMID: 31014995 PubMed
  15. Chen Y, Wang Y, Shen J. Role of environmental factors in the pathogenesis of Crohn's disease: a critical review. Int J Colorectal Dis. 2019 Dec;34(12):2023-2034. PMID: 31732875 PubMed
  16. Narula N, Chang NH, Mohammad D, Wong ECL, Ananthakrishnan AN, Chan SSM, Carbonnel F, Meyer A. Food Processing and Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2023 Sep;21(10):2483-2495.e1. PMID: 36731590 PubMed
  17. Marks DJ, Rahman FZ, Sewell GW, Segal AW. Crohn's disease: an immune deficiency state. Clin Rev Allergy Immunol. 2010 Feb;38(1):20-31. doi: 10.1007/s12016-009-8133-2. DOI
  18. Hong SM, Baek DH. Diagnostic Procedures for Inflammatory Bowel Disease: Laboratory, Endoscopy, Pathology, Imaging, and Beyond. Diagnostics (Basel). 2024 Jun 28;14(13):1384. PMID: 39001273 PubMed
  19. Coates MD, Clarke K, Williams E, Jeganathan N, Yadav S, Giampetro D, Gordin V, Smith S, Vrana K, Bobb A, Gazzio TT, Tressler H, Dalessio S. Abdominal Pain in Inflammatory Bowel Disease: An Evidence-Based, Multidisciplinary Review. Crohns Colitis 360. 2023 Sep 26;5(4):otad055. PMID: 37867930 PubMed
  20. Veauthier B, Hornecker JR. Crohn's Disease: Diagnosis and Management. Am Fam Physician. 2018 Dec 1;98(11):661-669. PMID: 30485038 PubMed
  21. Mu C, Zhao Q, Zhao Q, Yang L, Pang X, Liu T, Li X, Wang B, Fung SY, Cao H. Multi-omics in Crohn's disease: New insights from inside. Comput Struct Biotechnol J. 2023 May 13;21:3054-3072. PMID: 37273853 PubMed
  22. Singh JP, Aleissa M, Drelichman ER, Mittal VK, Bhullar JS. Navigating the complexities of perianal Crohn's disease: Diagnostic strategies, treatment approaches, and future perspectives. World J Gastroenterol. 2024 Nov 28;30(44):4745-4753. PMID: 39610776 PubMed
  23. Gordon H, Burisch J, Ellul P, Karmiris K, Katsanos K, Allocca M, Bamias G, Barreiro-de Acosta M, Braithwaite T, Greuter T, Harwood C, Juillerat P, Lobaton T, Müller-Ladner U, Noor N, Pellino G, Savarino E, Schramm C, Soriano A, Michael Stein J, Uzzan M, van Rheenen PF, Vavricka SR, Vecchi M, Zuily S, Kucharzik T. ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease. J Crohns Colitis. 2024 Jan 27;18(1):1-37. PMID: 37351850 PubMed
  24. van Rheenen PF, de Vijver EV, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010; 341: c3369. BMJ (DOI)
  25. Mosli MH, Zou G, Garg SK, Feagan SG, MacDonald JK, Chande N, Sandborn WJ, Feagan BG. C-Reactive Protein, Fecal Calprotectin, and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2015 Jun;110(6):802-19; quiz 820. PMID: 25964225 PubMed
  26. Holtman GA, Lisman-van Leeuwen Y, Reitsma JB, et al. Noninvasive tests for inflammatory bowel disease: A meta-analysis. Pediatrics 2016; 137:1-11. doi: 10.1542/peds.2015-2126 DOI
  27. Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008; 247: 64-79. Radiology
  28. Taylor SA, Mallett S, Bhatnagar G, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Miles A, Murray CD, Plumb AA, Pollok RC, Punwani S, Quinn L, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S; METRIC study investigators. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn's disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol. 2018 Aug;3(8):548-558. PMID: 29914843 PubMed
  29. Reese G, Woodfield G, Patel PH. Crohn's disease. BMJ Best Practice, last updated Feb 2018.
  30. Steinhart AH, Ewe K, Griffiths AM et al. Corticosteroids for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2008, Issue 4. The Cochrane Library
  31. Anisdahl K, Svatun Lirhus S, Medhus AW, Moum B, Melberg HO, Høivik ML. First-line biologic treatment of inflammatory bowel disease during the first 12 months after diagnosis from 2010 to 2016: a Norwegian nationwide registry study. Scand J Gastroenterol. 2021;56(10):1163-1168. PubMed
  32. Rozich JJ, Holmer A, Singh S. Effect of Lifestyle Factors on Outcomes in Patients With Inflammatory Bowel Diseases. Am J Gastroenterol. 2020 Jun;115(6):832-840. PMID: 32224703 PubMed
  33. Solberg IC, Vatn MH, Høie O, et al. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol. 2007 Dec;5(12):1430-8. PMID: 18054751 PubMed
  34. To N, Gracie DJ, Ford AC. The Importance of Smoking Cessation in Improving Disease Course in Crohn's Disease. Am J Gastroenterol. 2016;111(8):1198. PubMed
  35. Lambert B, Lemberg DA, Leach ST, Day AS. Longer-term outcomes of nutritional management of Crohn's disease in children. Dig Dis Sci 2012; 57: 2171-7. pmid:22661250 PubMed
  36. Zhan YL, Zhan YA, Dai SX. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin Nutr. 2017 May 24 . pmid:28587774 PubMed
  37. Gionchetti P, Dignass A, Danese S, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis. 2017 Feb;11(2):135-149. PubMed
  38. Tøttrup A. Laparoskopisk kirurgi ved inflammatorisk tarmsygdom. Ugeskr Læger 2010; 172: 2287. PubMed
  39. Torres J, Bonovas S, Doherty G, et al. ECCO Guidelines on Therapeutics in Crohn's Disease: medical treatment. European Crohn’s and Colitis Organisation (ECCO), 2019. outlook.office365.com
  40. Torres J, Boyapati RK, Kennedy NA, et al. Systematic Review of Effects of Withdrawal of Immunomodulators or Biologic Agents From Patients With Inflammatory Bowel Disease. Gastroenterology. 2015 ;149:1716-30. doi: 10.1053/j.gastro.2015.08.055. PMID:26381892 PubMed
  41. Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn's disease. Gastroenterology. 2006 Mar;130(3):650-6. PMID: 16530505 PubMed
  42. Kothari S, Afshar Y, Friedman LS, Ahn J. AGA Clinical Practice Update on Pregnancy-Related Gastrointestinal and Liver Disease: Expert Review. Gastroenterology. 2024 Oct;167(5):1033-1045. PMID: 39140906 PubMed
  43. Singh M, Wambua S, Lee SI, Okoth K, Wang Z, Fayaz FFA, Eastwood KA, Nelson-Piercy C, Reynolds JA, Nirantharakumar K, Crowe F; MuM-PreDiCT. Autoimmune diseases and adverse pregnancy outcomes: an umbrella review. BMC Med. 2024 Mar 5;22(1):94. PMID: 38438886 PubMed
  44. DeBolt CA, Gottlieb ZS, Rao MG, Johnson S, Rekawek P, Deshpande R, Meislin R, Berkin J, Bianco A, Mella MT, Dubinsky MC. Low-Dose Aspirin Use Does Not Increase Disease Activity in Pregnant Patients with Inflammatory Bowel Disease. Dig Dis Sci. 2024 May;69(5):1803-1807. PMID: 38493274 PubMed
  45. Grimstad T, Norheim KB. Utmattelse ved inflammatorisk tarmsykdom. Tidsskr Nor Lægeforen 2016; 136: 1721-24. pmid:27830906 PubMed
  46. Grimstad T, Norheim KB, Isaksen K et al. Fatigue in Newly Diagnosed Inflammatory Bowel Disease. J Crohns Colitis 2015; 9: 725-30. pmid:25994356 PubMed
  47. Hovde O, Kempski-Monstad I, Smastuen MC, et al. Mortality and causes of death in Crohn`s disease: results from 20 years of follow-up in the IBSEN study. Gut. 2013 Jun 6. PMID: 23744613. PubMed
  48. Follin-Arbelet B, Cvancarova Småstuen M, Hovde Ø, Jelsness-Jørgensen LP, Moum B. Mortality in Patients with Inflammatory Bowel Disease: Results from 30 Years of Follow-up in a Norwegian Inception Cohort (the IBSEN study). J Crohns Colitis. 2023 Apr 19;17(4):497-503. PMID: 36239614.
  49. Olén O, Askling J, Sachs MC et al. Mortality in adult-onset and elderly-onset IBD: a nationwide register-based cohort study 1964-2014. Gut 2019. Epub. 317572 pmid:31092591 PubMed
  50. Burisch J, Kiudelis G, Kupcinskas L, Kievit HAL, Andersen KW, Andersen V, Salupere R, Pedersen N, Kjeldsen J, D'Incà R, Valpiani D, Schwartz D, Odes S, Olsen J, Nielsen KR, Vegh Z, Lakatos PL, Toca A, Turcan S, Katsanos KH, Christodoulou DK, Fumery M, Gower-Rousseau C, Zammit SC, Ellul P, Eriksson C, Halfvarson J, Magro FJ, Duricova D, Bortlik M, Fernandez A, Hernández V, Myers S, Sebastian S, Oksanen P, Collin P, Goldis A, Misra R, Arebi N, Kaimakliotis IP, Nikuina I, Belousova E, Brinar M, Cukovic-Cavka S, Langholz E, Munkholm P; Epi-IBD group. Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut. 2019 Mar;68(3):423-433. PMID: 29363534 PubMed
  51. Ewe K, Herfarth C, Malchow H, Jesdinsky HJ. Postoperative recurrence of Crohn's disease in relation to radicality of operation and sulphasalazine prophylaxis: a multicenter trial. Digestion 1989; 42: 224-32. PubMed
  52. Yamamato T. The clinical value of faecal calprotectin and lactoferrin measurement in postoperative Crohn's disease. United European Gastroenterology Journal 2015; 3: 5-10. doi:10.1177/2050640614558106 DOI
  53. Panaccione R, Feagan BG, Afzali A, et al. Efficacy and safety of intravenous induction and subcutaneous maintenance therapy with guselkumab for patients with Crohn's disease (GALAXI-2 and GALAXI-3): 48-week results from two phase 3, randomised, placebo and active comparator-controlled, double-blind, triple-dummy trials. Lancet. 2025 Jul 17:S0140-6736(25)00681-6. PMID: 40684778. PubMed
Annonse
Annonse