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P349 The therapies influencing postoperative surgical recurrence in Crohn's disease

Shinozaki M.

The Institute of Medical Science, The University of Tokyo, Department of Surgery, Tokyo, Japan

Background

Postoperative recurrence is inevitable in most Crohn's disease patients. In result, multiple bowel resections may lead to short bowel syndrome, which may affect the patients' life. Therefore, we need to seek for optimal strategies to prevent progression of the disease postoperatively. Lately, anti-tumor necrosis factor alpha (TNFα) agents and endoscopic balloon dilatation have been used widely, and treatment strategy has been changing. This study was aimed to clarify which therapy was the most efficient to suspend the postoperative surgical recurrence in Crohn's disease in the era of these novel therapies.

Methods

Seventy operations were undergone in 46 Crohn's disease patients. There were 32 males and 14 females. Clinical data were obtained with retrospective chart review. The age at surgery was 19–74 (median: 34.5), and the duration of Crohn's disease was 0–30 (median: 8.5) years. The observation period ranged 100 to 7758 (mean: 1671) days. The therapies analysed were aminosalicylates, immunomodulators (azathiopurine, 6-mercaptopurine), anti-TNFα agents (infliximab, adalimumab), nutritional therapy including elemental diet, and endoscopic balloon dilatation. Survival curves were drawn, and log-rank tests were employed to evaluate statistically for univariate analysis. We ran proportional hazard model for multivariate analysis. A p value of <0.05 was considered to be significant.

Results

The patients who underwent anti-TNFα therapy had statistically better prognosis than those without (p=0.0276). Balloon dilatation seemed to be useful, because the prognosis of the patients who received dilatation technique had better prognosis (p=0.0167). Immunomodulators were effective to prevent surgical recurrence with statistical significance (p=0.0460). Patients who maintained elemental diet (more than 900 kcal/day) had statistically better prognosis than those without or with lower quantity (p=0.0010). By multivariate analysis, the only significant factor was the nutritional therapy (p=0.0186), followed by endoscopic balloon dilation therapy (p=0.0572).

Conclusion

Anti-TNFα therapy, immunomodulators, endoscopic balloon dilatation therapy, and elemental diet therapy were effective to suspend postoperative recurrence in Crohn's disease by univariate analyses. Elemental diet therapy was significantly associated with surgical recurrence by multivariate analysis, and there was a trend of advantage for endoscopic dilatation.