Factors affecting recurrence in Crohn's disease

Poggioli, Gilberto; Laureti, Silvio; Selleri, S; Brignola, C.; Grazi, Gian Luca; Stocchi, Luca; Marra, Claudio; Magalotti, Cesare; Grigioni, Francesco; Cavallari, A.

doi:10.1007/s003840050065

Cited by 60 publications

(57 citation statements)

References 28 publications

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“…Age: Subjects with a diagnosis of CD at a young age have higher rates of recurrence in some studies [14,15] but neither in others [16,17] nor in the present study.…”

Section: Patient Related Factorscontrasting

confidence: 68%

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

Makni¹

2017

Austin J Gastroenterol

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Objective: The surgery is required in more than 80% of patients with Crohn's disease. Crohn's disease is associated with high rates of postoperative recurrence. The aim of the study was to identify, the risk factors of postoperative 'surgical recurrence' after the first resection for Crohn's disease. Methodology:We report a retrospective study from January 1998 to September 2010 that studied 226 patients originated only from Tunisia (in North Africa), operated on for MC. We had been interested to the risk factor of surgical recurrence of Crohn's disease.Results: Mean age was 33 years. The average time between the onset of the disease and the surgical procedure was 31 months. The diagnosis of CD was established preoperatively in 213 patients (94%). The diagnosis was made intraoperatively because of an acute complication in 5 cases (2.2%) and postoperatively in 8 cases (3.5%). The most common location was the ileocecal junction in 184 cases (81.4%). The most common type of lesion was the mixed form (stricture and fistula) in 123 cases (54.4%). Operative mortality was 0.04% (n=1). Specific morbidity was 8.4% (n=19). In long term, a surgical recurrence was noted in 18 patients (8%). In multivariate analysis, independent risk factors for recurrence were: smoking (p=0.012, ORs=3.57) and post-operative medical treatment (p=0.05, ORs=2.6). Conclusion:Our series is unique for a lower rate of the postoperative recurrence (8%). The two risk factors of recurrence are smoking and the necessity of postoperative medical prophylaxis.

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“…Age: Subjects with a diagnosis of CD at a young age have higher rates of recurrence in some studies [14,15] but neither in others [16,17] nor in the present study.…”

Section: Patient Related Factorscontrasting

confidence: 68%

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

Makni¹

2017

Austin J Gastroenterol

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“…It has been suggested that several factors influence post-operative recurrence rates, including the duration of the disease before resection, smoking, pre-operative lymphopenia, the type of surgery, the site of Crohn’s disease, and the type of Crohn’s disease – perforating vs. non-perforating disease as well as the use of medications [3,4,5,6,7,8,9,10,11,12]. Some of the studies reported conflicting results regarding these factors.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Regarding the Need for a Second Operation in Patients with Crohn’s Disease

et al. 2005

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Background/Aims: The majority of Crohn’s disease patients undergo surgery. However, the factors that predict post-operative recurrence remain controversial. The aim of the present study was to shed light on the potential predictors of such recurrence. Methods: 86 patients who underwent operative procedures for Crohn’s disease were retrospectively studied. Recurrence was defined as the need for a second operation. Life table and multivariate analysis were performed to find the predictors of recurrence. Results: In 26/86 (30%) of the patients, post-operative recurrence was diagnosed within a mean of 42 months of the follow-up. Logistic regression analysis revealed that smoking (OR 3.69, 95% CI 2.06–11.52) and perforating disease (OR 4.09, 95% CI 1.31–12.65) were associated with a risk of recurrence. However, survival analysis showed that only perforating disease was associated with an early post-operative recurrence (log-rank test, p < 0.001). Neither resected surgical specimen characteristics, nor the duration and the location of the disease were found to predict the need for a second operation. Conclusion: The risk for Crohn’s disease patients who undergo surgery is related to the presence of perforating disease and smoking, which predict the need for a second operation. The former is associated with an even earlier recurrence.

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“…La recurrencia de la enfermedad en la zona de la anastomosis ileocolónica se produjo a los 7 y 11 años de la primera operación por EC, lo cual evidencia que a los 5 años en nuestra serie no se observaron recidivas que necesitaron de tratamiento quirúrgico, cifra que es menor a las publicadas [18][19][20] . Es necesario destacar que en esta serie no hubo un seguimiento endoscópico y/o radiológico protocolizado, de manera que pudo haber habido pacientes asintomáticos con recidiva endoscópica de la enfermedad que no se manifestaron clínicamen-te o que respondieron al tratamiento médico evitando así el tratamiento quirúrgico.…”

Section: Discussionunclassified

“…Así entonces, en esta serie, la cifra de recurrencia después de RIC de 7% a 9,5 años comprende la recurrencia clínica, demostrada radiológica o endoscópicamen-te con indicación operatoria. Usando un criterio similar, en otras series la prevalencia de recurrencia a 5 años en pacientes sometidos a cirugía por EC es de 13 a 24% [18][19][20] . El porcentaje de recurrencia es aún mayor, al realizar un seguimiento a más de 10 años desde la operación 21 .…”

Section: Discussionunclassified

Resección ileocecal por enfermedad de Crohn: Resultados y seguimiento

et al. 2008

Rev Chil Cir

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RESUMENIntroducción: Aproximadamente el 50% de los pacientes con Enfermedad de Crohn (EC) necesitarán de un tratamiento quirúrgico en algún momento de su evolución. La resección ileocecal (RIC) es una de las operaciones más frecuentes en pacientes con EC. Objetivo: Identificar las indicaciones quirúrgicas y determinar el porcentaje de recurrencia de la enfermedad a largo plazo de los pacientes sometidos a RIC por EC. Material y método: Se incluyeron todos los pacientes sometidos consecutivamente a RIC entre Enero 1970 y Diciembre 2006 y se analizaron características demográficas, indicación operatoria, variables intraoperatorias, complicaciones y, en el seguimiento, la recurrencia de la enfermedad. Resultados: 28 pacientes fueron operados en el periodo mencionado. 17 mujeres (60,7%), edad promedio del diagnóstico de EC: 34,8 años (i: 14-60) y de la RIC: 43,3 años (i: 16-68). Seis pacientes habían sido operados previamente por EC (3 sobre el periné y 3 resecciones parciales de intestino, no RIC). Una o más de las siguientes condiciones contribuyeron a la indicación quirúrgica: Obstrucción intestinal intermitente en 21 pacientes, refractariedad a tratamiento médico en 10, fístula enteral en 2 y hemorragia digestiva baja en 2. Nueve pacientes (32,1%) tuvieron una o más complicaciones postoperatorias, 3 (10%) de los cuales fueron reintervenidos (2 por filtración de la anastomosis, uno por hemoperitoneo). La mediana de estadía postoperatoria fue 9 días. No hubo mortalidad operatoria. En el seguimiento a largo plazo, 3 pacientes desarrollaron ileo mecánico por bridas. Todos ellos resueltos quirúrgicamente. Cuatro pacientes (14%) fueron reintervenidos por recidiva de la EC con tiempo medio desde la RIC de 63 meses. La sobrevida a 5 años fue de 96%. Conclusión: La RIC por EC, se indica principalmente por obstrucción intestinal debida a estenosis. La estenosis en la recidiva de la enfermedad es baja.PALABRAS CLAVE: Enfermedad de Crohn, tratamiento quirúrgico, resección ileocecal. ABSTRACTBackground: Approximately 50% of patients with Crohn`s disease (CD) will need a surgical treatment in the long term course of the disease. The ileocaecal resection (ICR) is the most common operations in patients with CD. Aim: To identify the surgical indications and to determine the rate of recurrence in late

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Factors affecting recurrence in Crohn's disease

Cited by 60 publications

References 28 publications

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

Risk Factors Regarding the Need for a Second Operation in Patients with Crohn’s Disease

Resección ileocecal por enfermedad de Crohn: Resultados y seguimiento

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