P340 Postoperative clinical recurrence in Crohn’s disease patients: the Practicrohn study
E. Domènech*1, V. García2, M. D. Martín Arranz3, M. Barreiro-de Acosta4, A. Gutiérrez5, L. Cea-Calvo6, C. Romero6, B. Juliá6
1Hospital Universitari Germans Trias i Pujol and CIBERehd, Gastroenterology Unit, Badalona, Spain, 2Hospital Universitario Reina Sofia, Unidad Clinica de Aparato Digestivo, Cordoba, Spain, 3Hospital Universitario La Paz, Gastroenterology Unit, Madrid, Spain, 4Complejo Hospitalario Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain, 5Hospital General Universitario Alicante, Gastroenterology Unit, Alicante, Spain, 6MSD Spain, Medical Department, Madrid, Spain
More than 50% of patients with Crohn’s disease (CD) require intestinal resection at least once during the course of their disease. Patients with Rutgeerts score i0 and i1 have a favourable clinical course, whereas Rutgeerts score > i2 is associated with higher risk of developing symptoms and complications. The aim of this study was to explore the incidence and management of postoperative recurrence in a population of CD patients from the Practicrohn study.
Practicrohn was a retrospective study performed in 26 Spanish hospitals, including patients aged ≥ 18 years old who underwent CD-related ileocolonic resection between January 2007 and December 2010. Patient’s data before and up to 5 years after surgery were collected retrospectively from medical records. Clinical recurrence was defined as suggestive clinical symptoms (diarrhoea, abdominal pain, abscess, or mass) and one of the following: endoscopic Rutgeerts score ≥ 2 and/or CT or MRI confirmatory of disease activity, performed within 6 months of symptoms. Categorical variables were compared with the χ2 test or Fisher’s exact test Kaplan–Meier method was used to assess time to clinical recurrence and a log-rank test to obtain the statistical significance.
In total, 314 patients were analysed (mean age 40 years [SD 13], 48% men). Of these, 149 (51%) were smokers at CD diagnosis, and 115 (77%) kept on smoking at the time of surgery. Median time from CD diagnosis to surgery was 6 years (IQR 1–12). Indication for surgery was 147 (48%) stenosing, 98 (32%) penetrating disease, 46 (15%) stenosing+penetrating, and 14 (4%) refractoriness to medical treatment. Further, 208 (68%) of patients received preventive therapy for recurrence after surgery: 13% aminosalycilates, 9% antibiotics, 46% immunomodulators (IMM), and 1% anti-TNFs. Moreover, 97patients (31%) met the predefined criteria of clinical recurrence (median time to recurrence 315 days (IQR 65–748)). Cumulative probability of clinical recurrence was 16%, 27%, and 31% at 1, 3, and 5 years, respectively. Clinical recurrence was 25% in patients with IMM prophylactic therapy and 41% without prophylaxis (p = 0.014). During follow-up, 44 patients (14%) needed surgical reintervention with median time to surgical reintervention of 228 days IQR 25–75 (133–527).
Figure 1. “Kaplan-Meier curve of survival without recurrence in patients with different prophylactic treatments”
Almost one-third of CD patients who underwent intestinal resection do not start early prophylaxis for recurrence. The risk of clinical recurrence in clinical practice was about 30 % within the first 5 years after surgery; only IMM seemed to reduce it, and 14% of the patients needed surgical reintervention.