P405. Predictors of endoscopic recurrence in a long term follow up cohort of Crohn's disease patients – How effective is azathioprine? A single tertiary referral center experience
Y. Erzin1, G. Sisman1, I. Hatemi1, B. Baca2, I. Hamzaoglu3, A. Dirican4, A.F. Celik1, 1Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 2Istanbul University Cerrahpasa Medical Faculty, Surgery, Istanbul, Turkey, 3Istanbul Univesrity Cerrahpasa Medical Faculty, Surgery, Istanbul, Turkey, 4Istanbul University Istanbul Medical faculty, Biostatistics, Turkey
Background
Aim was to determine the predictors of endoscopic recurrence in a cohort of CD patients with prior intestinal resections.
Methods
CD patients' charts were reviewed in a retrospective manner. 104 of 537 (19%) CD patients had a history of prior intestinal resection. 21/104 (20%) were either lost to follow-up or had no postoperative (postop.) colonoscopy, so 83 patients were eligible for the final analysis. Age at disease onset, at resection, at the last postop. colonoscopy; presence of family history, sex, disease location, and behavior, presence of perianal fistulae, postop. smoking, postop. medications were noted. Rutgeerts score was used to define postop. endoscopic recurrence.
Results
The patients' mean age±SD at their final colonoscopy was 42.81±11.99 yr, at operation: 36.32±11.23 yr, 45% being female. The mean follow-up time between resection and the final colonoscopy was 45 (range, 2–300) months. 13/83 (16%) patients had their 2nd resection. 45/83 patients (54%) had an ileocecal resection without any postop. residual disease in the remnant intestine. 51/83 (61%) patients were in endoscopic remission whereas 32 (39%) were not. There was no difference regarding age at disease onset, at operation, at colonoscopy, and the time from resection to the latest colonoscopy, sex or disease duration, behavior, location, smoking status, and family history between patients with and without endoscopic recurrence. 9/32 (28%) with endoscopic recurrence compared to 4/51 (8%) without relapse had a history of a 2nd resection (p = 0.013), disclosing a 3.58 (1.2–10.68) fold risk for relapse. The presence of any postop. residual disease was another risk factor [p = 0.015; OR: 1.77 (1.12–2.8)] but the regular use of azathioprine (AZA), defined as its use at least in 85% of postop. time period, was found to be a protective factor [p = 0.022; OR: 1.35 (1.06–1.72)]. In a logistic regression analysis all the three variables proved to be independent predictors of relapse (p = 0.013, p = 0.015, p = 0.022 for a history of a 2nd resection, for the presence of any postop. residual disease, and for the absence of regular AZA use, respectively).
Conclusion
Having multiple resections for CD was identified as one of the risk factors for endoscopic recurrence, and the strict regular use of AZA seemed to add a little positive effect in preventing endoscopic relapse. The presence of any residual disease after resection came out as an independent risk factor for relapse, an issue never mentioned in previous reports.