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Post-operative recurrence of Crohn's disease: a prospective study at 5 years

Digestive and Liver Disease, In Press, Accepted Manuscript, Available online 29 January 2016

Abstract

Background

We aimed to prospectively assess whether endoscopic recurrence severity at 1 year in Crohn's disease is predictive of clinical recurrence within 5 years.

Methods

Clinical recurrence (Crohn's Disease Activity Index > 150) was assessed yearly for 5 years in Crohn's disease patients undergoing ileo-colonic resection. At 1 year, recurrence was assessed by colonoscopy (Rutgeerts’ score ≥i1 or ≥2i) and small intestine contrast ultrasonography.

Results

40 patients were included (23 males, median age 39 [16-69] years). Clinical recurrence occurred within 5 years in 16 (40%) patients (years 1, 2, 3, 4, 5: 2 [5%];10 [25%];4 [10%];2 [5%];4 [10%], respectively). At 1 year, endoscopic recurrence (score≥i1) occurred in 39 (97.5%) patients (score≥i2:33 [82.5%]). Ultrasound detected lesions compatible with recurrence in 39/40 (97.5%) patients. Endoscopic score at 1 year was correlated with clinical score at 2 years (p = 0.007;r = 0.41). Endoscopic score at 1 year was higher in patients with (n = 10) vs without (n = 30) clinical recurrence at 2 years (3 [2-4] vs 2 [0-4];p = 0.003). Higher endoscopic score (>i2) at 1 year was a risk factor for clinical recurrence within 5 years (OR = 0.18;95%CI 0.04-0.71;p = 0.008).

Conclusions

In Crohn's disease, severity of endoscopic recurrence at 1 year remains a predictive marker of clinical recurrence within 5 years. Small intestine contrast ultrasonography is useful for assessing 1-year recurrence.

Keywords: Crohn's Disease, Postoperative Recurrence, Ileocolonoscopy, Small Intestine Contrast Ultrasonography, endoscopic recurrence.

Footnotes

a GI Unit, Department of Systems Medicine

b Surgical Unit, Department of Surgery

c Department of Statistic, University of Rome “Tor Vergata”, Italy

Corresponding author. GI Unit Department of Systems Medicine University of Rome “Tor Vergata” Via Montpellier, 1 00133 Rome, Italy Tel.: +39 06 20903737; +39 06 20908390; fax: +39 06 20903738