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P235 Endoscopic, clinical, and surgical recurrence of Crohn's disease: In which direction are we going?

Campanati L., Indriolo A., Giulii Capponi M., Panyor G., Lotti M., Rubertà F., Giussani M., Poiasina E., Cosimo P., Ansaloni L., Ravelli P.

Papa Giovanni XXIII Hospital, Bergamo, Italy

Background

Crohn's Disease (CD) is a complex and heterogeneous disease, which requires the collegial effort of a multidisciplinary team which is motivated and constantly updated on the many facets of the disease. One of the unresolved issues is the recurrence of CD, which greatly affects the quality of life of those patients [1,2].

In an effort to understand where we are going and to improve ourselves we decided to retrospectively review our tertiary center experience, focusing on our data about endoscopic, clinical and surgical relapses after first major surgery.

Methods

We retrospectively reviewed our database dedicated on inflammatory bowel diseases from 2000 to October 2016, selecting patients affected by CD. We evalueted the mean duration of their follow up and we considered only the group of patients with at least 5 years follow up. We recorded the their demographic characteristics, the age at diagnosis of CD, the primary site of disease, the type of first surgery, the incidence of endoscopic, clinical and surgical recurrent disease after surgery.

We considered patients with Rutgeerts score ≥i2 affected by endoscopic relapse; patients with CDAI >150 affected by clinical relapse; patients who needed further surgery were considered affected by surgical relapse.

Results

215 patients affected by CD have come to our attention since 2000. Among them, 92 patients undewent major surgery almost once and only 47 patients (51%) reached at least a 5 years follow up after operation. Male patients were 25 (53,2%). The mean age of CD onset was 34 years old. Smokers were 32 (48%).

The patterns of gastro-intestinal involvement of those patients at diagnosis were: ileum (L1) in 13 patients (27,7%), colon (L2) in 11 patients (23,4%), ileum plus colon (L3) in 23 patients (48,9%).

25 patients (53,2%) underwent major surgery in emergency setting.

At follow up, cumulative endoscopic relapse rates were 38,3%, 59,6% and 74,5% at 1, 3 and at 5 years after operation, respectively. Clinical recurrence affected 8,5% of patients at 1 year, 19,1% at 3 years, 44,7% at 5 years. Finally surgical recurrence accounted for 2,1%, 12,8% and 14,9% at 1, 3, 5 years of follow up, respectively. (Figure 1).

Figure 1. Cumulative recurrence rates in patients who underwent major surgery.

Conclusion

In line with what has long been known, CD ineluctably tends to recur. [3] The incidence of endoscopic recurrence remains consistently high over time. The clinical recurrence shows a gradual trend of increase. Surgical recurrence shows a low incidence for the entire follow-up.

References:

[1] Spinelli A, Sacchi M, Fiorino G, Danese S, Montorsi M., (2011), Risk of postoperative recurrence and postoperative management of Crohn's disease, World J Gastroenterol, 3213–9

[2] Lee YW, Lee KM, Chung WC, Paik CN, Sung HJ, Oh YS, (2014), Clinical and endoscopic recurrence after surgical resection in patients with Crohn's disease, Intest Res, 117–23

[3] Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L., (2012), Review article: the natural history of postoperative Crohn's disease recurrence, Aliment Pharmacol Ther, 625–33