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P433 Postsurgical recurrence in Crohn's disease. Multicenter study in the region of Murcia, Spain of GEMEII group

García Albert A.M.1, García-Paredes R.*2, Torrella Cortés E.3, Martinez-Jimenez T.4, Angel Rey J.M.4, García-Tercero I.2, Castillo Espinosa J.M.5, Torregrosa Lloret M.3, Chacόn Martínez S.3, Andreu Plaza J.6, Rodríguez Lozano A.2

1Reina Sofía-Murcia Hospital, Gastroenterology, Murcia, Spain 2Santa Lucía Hospital, Gastroenterology, Cartagena, Spain 3Morales Meseguer Hospital, Gastroenterology, Murcia, Spain 4Rafael Mendez Hospital, Gastroenterology, Lorca, Spain 5Los Arcos Hospital, Digestive Disease, Cartagena, Spain 6Virgen del Castillo Hospital, Gastroenterology, Yecla, Spain

Background

Postsurgical recurrence in Crohn'se disease is a frequent problem. Severity of endoscopic reccurrence, correlates with the later development of clinical recurrence, its severity and also with complications and requirement of new surgery.

The objective of the present study is to describe the characteristics of Crohn's disease patients included, determining associated presurgical parameters with the intervention, and characteristics associated with the postsurgical recurrence of the disease, evaluating the endoscopic recurrence through the Rutgeerts Index in the 12 months after the surgery.

Methods

Multicenter retrospective longitudinal study in the Region of Murcia in Spain. 6 hospitals participated. Includes patients of Ileo-Cecal Crohn's disease during 5 years, from January of 2008 to January of 2013. Variables: sociodemografics, tobacco, Montreal classification, disease severity, treatment prior to intervention and after surgery, cause of intervention, endoscopic control during the year of the intervention and need of therapeutic intensification based on the endoscopic activity after surgery. Statistical analysis by means of Epinfo program: bivariant analysis of association between the different variables gathered and variable results defined by the necessity of surgery, the postsurgical recurrence and the response to the medical treatment after the surgery.

Results

71 patients: (49 men and 22 women) with average age of 35.8 years (DS: 13.2). Inflammatory phenotype 27%, fibro-estenotic 24% and fistulyzing 49%. Smokers to diagnosis 49%. Rutgeerts endoscopyc index at the year of surgery: 75% i0–i1; 25% superior to i1. In the bivariant analysis the positive findings for association were: presurgical corticodependence and presence of endoscopic activity at the year of the surgery (Rutgeerts >i0) with OR=3.24 (CI 1.04–10.07); previous biological treatment to Surgery: with Infliximab and Rutgeerts recurrence >i0 with OR=5.9583 (CI 1.5707–22.6018). With Adalimumab OR=3.8462 (CI 1.0849–13.6350. Association between sex, age, phenotypic pattern (Montreal), tobacco or cause of surgery with endoscopic recurrence to the year of surgery has not been obtained.

Table 1. Bivariant analysis

Bivariant analysis: positive association findingsOR (95% CI)
Infliximab treatment prior surgery + postsurgical endoscopic recurrence Rutgeerts index >i05.9583 (1.5707–22.6018)
Adalimumab treatment prior surgery + postsurgical endoscopic recurrence Rutgeerts index >i03.8462 (1.0849–13.6350)
Corticodependence prior surgery + postsurgical endoscopic recurrence Rutgeerts index >i03.24 (1.04–10.07)

Conclusion

Only 25% of our patients presented index of endoscopic recurrence to the year of the surgery of high risk of progression (i2–i4 of Rutgeerts). In our environment, the biological treatment and corticodependence previous to the surgery are associated with endoscopic activity in the year of the surgical intervention.