P269 Phenotypic predictors of endoscopic recurrence after ileal resection for Crohn's disease: an NIDDK IBD Genetics Consortium prospective study
Boland K.*1, Haritunians T.2, Schumm L.P.3, McGovern D.2, Brant S.R.4, Rioux J.L.5, Sharma Y.6, Duerr R.7, Cho J.6, Silverberg M.1
1Mount Sinai Hospital, Zane Cohen Center for Digestive Diseases, Toronto, Canada 2Cedars-Sinai, F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, United States 3University of Chicago, Department of Public Health, Chicago, United States 4The Johns Hopkins Hospital Division of Gastroenterology, Meyerhoff Inflammatory Bowel Disease Center, Baltimore, United States 5Universite de Montreal, Montreal, Canada 6Mount Sinai, Icahn School of Medicine, New York, United States 7University of Pittsburgh, Department of Gastroenterology, Pittsburgh, United States
Disease recurrence in patients after ileal resection of Crohn's Disease (CD) is predictable and represents an excellent model to study the mechanisms of intestinal inflammation in an at-risk population. Our aim is to investigate genomic and microbial factors associated with post-operative endoscopic recurrence (ER). Here we present preliminary phenotypic analysis of recruited subjects to a prospective NIDDK Inflammatory Bowel Disease Genetics Consortium longitudinal study.
Patients with CD scheduled to undergo ileocolic resection with primary anastomosis were recruited at 6 North American research centres using a standardised protocol. Clinical data and bio specimen collection for microbiome and histological assessment was performed pre-operatively and at follow up. A Rutgeert's score of at least i2 determined endoscopic recurrence. Bivariate analysis (χ2 test) was performed using Graphpad.
294 patients were enrolled up to August 2016 and 122 had at least 1 post-operative endoscopy. The overall recurrence rate in the neo-terminal ileum up to 18 months was 33.6% (n=41/122). Early ER was present in 23.7% (n=29/122) at a median 6 months. CD recurrence was not significantly associated with Montreal classification, age, gender, smoking, or previous hospitalisations. Patients with a prior history of ileal resection had a higher risk of post-operative ER (p=0.004, RR 2.6 95% CI [1.5–3.8], n=9/41 vs n=3/81). Peri operative steroids (p=0.002, RR 3.4 95% CI [1.46–8.9]), combined immune suppressants and anti-TNF agents (p=0.028) and anti-TNF monotherapy use (p=0.056, RR 1.03 95% CI [1.002–4.04]) were associated reduced likelihood of ER. Use of anti-TNF therapy post-operatively was also associated with reduced recurrence (p=0.03, RR 2.81 95% CI [1.18–7.3], 15.7%, n=6/38 vs 41.6%, n=35/84). Patients recruited in the USA were more likely to receive anti-TNF therapy prior to first post-operative endoscopy (p=0.02, RR 2 95% CI l1.4–3.6]). Early recurrence rates were higher in Canadian centres although this was not statistically significant (p=0.45 [20% vs 40%]).
Preliminary phenotypic results showed that previous surgery predicted endoscopic post-operative recurrence, potentially indicating a more aggressive phenotype. Steroid exposure perioperatively and use of anti-TNF biologic therapy peri- and post-operatively before colonoscopy were associated with lower risk of endoscopic recurrence, validating studies which show benefit of anti-TNF in prevention of post-operative recurrence. Future studies in this population will investigate microbial and transcriptomic profiles related to disease recurrence and ongoing recruitment will further expand our cohort