Crohn's disease management after intestinal resection: a randomised trial

Cruz, Peter De; Kamm, Michael A.; Hamilton, Amy L.; Ritchie, Kathryn; Krejany, Efrosinia O.; Gorelik, Alexandra; Liew, Danny; Prideaux, Lani; Lawrance, Ian C.; Andrews, Jane M.; Bampton, Peter A.; Gibson, Peter R.; Sparrow, Miles P.; Leong, Rupert W.; Florin, Timothy H.; Gearry, Richard B.; Radford‐Smith, Graham; Macrae, Finlay; Debinski, Henry; Selby, Warwick; Kronborg, Ian; Johnston, Michael; Woods, Rodney; Elliott, Peter R.; Bell, Sally; Brown, Steven J; Connell, William; Desmond, Paul

doi:10.1016/s0140-6736(14)61908-5

Cited by 503 publications

(449 citation statements)

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“…As endoscopies are also invasive, expensive, and time-consuming with a risk of complications, there is a need for noninvasive screening methods for detecting relapse and postoperative recurrence of CD. Clinical activity indices and serum inflammatory markers correlate poorly with endoscopic disease activity [9,17,18,21]. Fecal calprotectin, which is excreted by migrating neutrophils to the lumen of the inflamed bowel, has been demonstrated a useful surrogate marker for disease activity in both children and adults [18,21,22,31,32].…”

Section: Discussionmentioning

confidence: 99%

“…A recent multicenter randomized trial among adult CD patients recommended postoperative endoscopic monitoring at 6-month intervals [9]. FC measurement could reduce the need for postoperative ileocolonoscopies by recognizing patients with probable disease recurrence who require medication intensification.…”

Section: Discussionmentioning

confidence: 99%

“…Ileum is affected in 70% of children and is prone to stricture and fistula formation, which occur in about 25% of pediatric CD patients [3,4,6]. Resection of the affected bowel segment either because of such complications or for unresponsive luminal disease is performed in 30-50% of pediatric CD patients by young adulthood [4,7] and as many as 70% of operated patients require further surgery during their lifetime [8,9].…”

mentioning

confidence: 99%

“…Recurrent mucosal inflammation is observed in endoscopy in 70-90% of adult CD patients within a year of surgery although only one third present with symptomatic relapse of the disease [1,[8][9][10]. Histological activity may develop at the site of the anastomosis as soon as after a week of bowel resection [11].…”

mentioning

confidence: 99%

“…Even though longer postoperative remission periods are reported for children, most studies have monitored clinical recurrence rates instead of endoscopic follow-up [2,[12][13][14][15]. As clinical symptoms are frequently absent and serum biochemical markers normal until significant inflammatory changes have developed, ileocolonoscopy with histological verification should be considered as the gold standard for assessing disease activity and postoperative recurrence [6,[8][9][10]16].…”

mentioning

confidence: 99%

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Fecal calprotectin in the prediction of postoperative recurrence of Crohn's disease in children and adolescents

Hukkinen

Pakarinen

Merras‐Salmio

et al. 2016

Journal of Pediatric Surgery

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a b s t r a c t a r t i c l e i n f oBackground: Fecal calprotectin (FC) correlates with endoscopic recurrence of Crohn's disease (CD) in adults but has not been studied among children postoperatively. We aimed to analyze whether FC relates with postoperative CD recurrence in children. Methods: Altogether 51 postoperative endoscopies and FC measurements from 22 patients having undergone surgery for CD at age ≤18 years were included. Results: Ileocecal resection (n = 15), small bowel resection (n = 6), or left hemicolectomy (n = 1) was performed at median age of 15.1 (interquartile range 14.4-17.6) years. Following surgery, FC decreased significantly (659 vs. 103 μg/g, p = 0.001). During median follow-up of 5.7 (4.2-7.7) years, either endoscopic or histological recurrence occurred in 17 patients (77%). FC N139 μg/g at time of endoscopy or FC increase of 79 μg/g compared to first postoperative value was suggestive of endoscopic recurrence (Rutgeerts score i2-i4), while FC N101 μg/g or increase of 21 μg/g indicated histological recurrence. Best accuracy for prediction of recurrence was obtained by combining FC at endoscopy and the postoperative increase of FC. The corresponding AUROC values were 0.74 (95% 0.58-0.89) for endoscopic recurrence whereas 0.81 (95% CI 0.67-0.95) for histological recurrence. Conclusion: FC is a useful surrogate marker of postoperative recurrence also in pediatric CD patients.

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