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P280. Analysis of the risk factors determining postoperative disease recurrence in an Irish Crohn's disease cohort

S. O'Donnell, S. O'Keefe, O. Loretta, S. Stewart, T. Kelleher, J. Leyden, P. MacMathuna

The Mater Hospital, Dublin, Ireland

Aims: Up to 80% of patients with Crohn's disease will require surgery at some stage during their lifetime. As surgery is not curative the prevention of postoperative recurrence is an important consideration. The role of immunosuppressant agents and biologic therapies remains unclear. Here we aim to assess the factors predicting postoperative recurrence of Crohn's disease at our institution.

Materials and Methods: The IBD database at our institution was interrogated to identify patients who have undergone surgery for Crohn's disease from 1995 to 2008. Risk factors for Crohn's disease recurrence including smoking history, family history of IBD, disease site and behaviour (inflammatory/stricturing/fistualising) were recorded. Medications pre- and post-operatively were characterised. Disease recurrence was defined by a need for further surgery, radiological evidence of new strictures or internal fistulae or introduction of a biologic therapy. Pearson χ2 was used to compare the frequency of postoperative recurrence between groups. A questionnaire was sent out to members of the Irish Society of Gastroenterology to assess current clinical practices in postoperative prophylaxis of recurrence.

Results: 80 patients were identified. Median time from diagnosis to surgery was 4 years and the median follow up period after the initial surgery was 7.5 years. 47% of patients had a disease recurrence during the study period. 30% of patients were smokers postoperatively. 32% had a family history of IBD. 37.5% had inflammatory disease, while 27.5% had stricturing and 31.5% had internal fistualising disease. We did not observe any significant association between continued smoking (p = 0.362), a family history of IBD (p = 0.347), perianal disease (p = 0.249) or complicated disease behaviour (p = 0.277) and a post-operative disease recurrence. 40% of cases were immunosuppressant (azathioprine or 6MP) naive pre-operatively and 88% were biologic therapy (Infliximab or adalimumab) naive. 41 (52%) patients were on an immunosuppressant postoperatively, and of these 56.8% had a disease recurrence. 13 (17%) patients were on a biologic therapy postoperatively; 12 of these suffered a disease recurrence. Those with a disease recurrence were on a significantly greater number of immunomodulators (immunosuppressant or biologic) postoperatively than those without; (mean number of immunomodulators of 0.83 versus 0.49, p = 0.013). A survey of 6 Irish institutions revealed a wide variation in practices in post-operative prophylaxis.

Conclusion: While the observation that smoking was not a predictive factor for post operative recurrence is a surprise; the study confirms the view that significant postoperative recurrence reflects an aggressive phenotype irrespective of postoperative prophylactic therapies.