Therapeutic strategies in Crohn’s disease in an emergency surgical setting

Table 1 Variables independently associated with abscess in the clinical score of Khoury et al[25]

Parameters	Coefficient estimate	P value	Weight appointed for the score
Ileo-colonic location	0.32 ± 0.16	0.04	× 1
Perianal disease	1.17 ± 0.32	0.0002	× 3
Absence of current corticosteroids	0.62 ± 0.21	0.003	× 2
NLR > 11.75	1.15 ± 0.17	< 0.0001	× 3
CRP > 0.5 mg/dL	1.67 ± 0.21	0.03	× 5

Modified from Khoury et al[25]. NLR: Neutrophil/lymphocyte ratio; CRP: C-reactive protein.

Table 2 Harvey-Bradshaw index (simple index)

Variable No.	Variable description
1	General well-being (0 = Very well; 1 = Slightly below par; 2 = Poor; 3 = Very poor; 4 = Terrible)
2	Abdominal pain (0 = None; 1 = Mild; 2 = Moderate; 3 = Severe)
3	Number of liquid stools daily
4	Abdominal mass (0 = None; 1 = Dubious; 2 = Definite; 3 = Definite and tender)
5	Complications: arthralgia, uveitis, erythema nodosum, aphthous ulcer, pyoderma gangrenosum, anal fissure, new fistula, abscess (score 1 for item)

Modified from Harvey and Bradshaw[26].

Table 3 Crohn’s disease activity index

Variable No.	Variable description	Multiplier
1	Number of liquid or soft stools (each day for 7 d)	× 2
2	Abdominal pain, sum of 7 daily ratings (0 = None, 1 = Mild, 2 = Moderate, 3 = Severe)	× 5
3	General well-being, sum of 7 daily ratings (0 = Generally well, 1 = Slightly under par, 2 = Poor, 3 = Very poor, 4 = Terrible)	× 7
4	Number of listed complications (arthritis or arthralgia, iritis or uveitis, erythema nodosum or pyoderma gangrenosum or aphthous stomatitis, anal fissure or fistula or abscess, other fistula, fever over 37.8 °C	× 20
5	Use of diphenoxylate or loperamide for diarrhea (0 = No, 1 = Yes)	× 30
6	Abdominal mass (0 = No, 2 = Questionable, 5 = Definite)	× 10
7	Hematocrit (males 47-Hct %, females 42-Hct %)	× 6
8	Body weight (1-weight/standard weight) × 100 (add or subtract according to sign)	× 1

Modified from Best et al[29]. Hct: Hematocrit.

Table 4 Incidence of acute complications in Crohn’s disease

Complication	Incidence (%)	Ref.
Small bowel obstruction	35.0-59.0	[63]
Gastroduodenal obstruction	0.5-15.0	[64]
Colonic strictures	5.0-17.0	[73]
Intra-abdominal abscess	10.0-28.0	[85,156]
Free bowel perforation	1.0-6.5	[104,105]
Acute appendicitis	0.1-2.0	[113]
Bleeding	1.0-6.0	[126]
Perianal disease with left-sided colon or rectal involvement	17.0-43.0	[145]
Isolated perianal involvement	5.0	[146]

Table 5 Endoscopic scoring system for postoperative recurrence

Grade	Endoscopic findings
0	No endoscopic recurrence
1	≤ 5 aphthous lesions
2	> 5 aphthous lesions with normal mucosa between the lesions, or skip areas of larger lesions, or lesions confined to ileocolonic anastomosis
3	Diffuse aphthous ileitis with diffuse inflammation of the mucosa
4	Diffuse inflammation with larger ulcers, nodules, and/or narrowing

Modified from Rutgeerts et al[131].

Table 6 Perianal Crohn’s disease activity index

Categories affected by fistulas	Score
Discharge
No discharge	0
Minimal mucous discharge	1
Moderate mucous or purulent discharge	2
Substantial discharge	3
Gross fecal soiling	4
Pain/restriction of activities
No activity restriction	0
Mild discomfort, no restriction	1
Moderate discomfort, some limitation of activities	2
Marked discomfort, marked limitation	3
Severe pain, severe limitation	4
Restriction of sexual activity
No restriction sexual activity	0
Slight restriction sexual activity	1
Moderate limitation sexual activity	2
Marked limitation sexual activity	3
Unable to engage in sexual activity	4
Type of perineal disease
No perineal disease/skin tags	0
Anal fissure or mucosal tear	1
< 3 Perianal fistulae	2
≥ Perianal fistulae	3
Anal sphincter ulceration or fistulae with significant undermining of skin	4
Degree of induration
No induration	0
Minimal induration	1
Moderate induration	2
Substantial induration	3
Gross fluctuance/abscess	4

Modified from Irvine[151].