Male gender, active smoking and previous intestinal resection are risk factors for post‐operative endoscopic recurrence in Crohn's disease: results from a prospective cohort study

Abstract

Summary Background After ileocaecal resection for Crohn's disease (CD), inflammatory lesions frequently recur on the anastomosis and/or on the neo‐terminal ileum. Aim To identify predictors of early post‐operative endoscopic recurrence. Methods From September 2010 to September 2017, the REMIND group conducted a prospective nationwide study in nine French academic centres. Data were collected at the time of surgery and endoscopy, performed 6‐12 months after surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥i2. Baseline factors associated with endoscopic recurrence were searched by univariate and multivariate regression analysis. Results Two hundred and eighty‐nine CD patients were included. Endoscopy within 1 year following surgery was performed in 225 (78%) patients (104M/121F). Mean age and disease duration were 35 (12.2) and 8.8 (8.9) years respectively. Seventy (32%) patients were active smokers at surgery. One hundred and forty‐two (63%) patients received at least one anti‐TNF therapy before surgery. After surgery, 40 (18%) patients received thiopurines and 66 (29%) received an anti‐TNF agent. Endoscopic recurrence occurred in 107 (47%) patients. In multivariate analysis, male gender (OR = 2.48 [IC 95% 1.40‐4.46]), active smoking at surgery (OR = 2.65 [IC 95% 1.44‐4.97]) and previous resection (OR = 3.03 [IC 95% 1.36‐7.12]) were associated with a higher risk of endoscopic recurrence. Inversely, post‐operative anti‐TNF treatment decreased the risk of endoscopic recurrence (OR = 0.50 [IC 95% 0.25‐0.96]). Conclusions Male gender, active smoking at surgery and previous intestinal resection are associated with a higher risk of endoscopic post‐operative recurrence, while post‐operative anti‐TNF treatment is associated with a lower risk.

Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn’s Disease

“…The present work was undertaken on a prospective multicenter study performed by the groupe de REcherche sur les Maladies INflammatoires Digestives (REMIND group) that aimed at identifying predictors of early postoperative endoscopic recurrence. 7 Patients were included between September 2010 and December 2016. Inclusion criteria were: >18 years of age, ileal or ileocolonic CD and indication of CD-related intestinal surgery (ileocolonic resection).…”

“…4 Several risk factors have been reported to increase postoperative recurrence, including active smoking, penetrating disease, history of perianal disease, previous intestinal surgery, and male sex. [5][6][7] There is still a need for factors that can accurately risk-stratify patients. 8 Macroscopically involved ileal margin could increase postoperative recurrence risk but this assumption was pushed aside in 1996 by Fazio et al 9 with the results of a randomized controlled trial showing no benefit of extended resection (clearance of 12 cm vs 2 cm of normal ileal margin).…”

“…We performed this study on a wellcharacterized prospective multicenter cohort of CD patients followed from surgery. 7…”

Editorial: predicting recurrence of Crohn's disease after surgical resection—close to a crystal ball

“…Auzolle and colleagues have precisely addressed this gap . In a meticulous prospective nationwide cohort study from the REMIND group, comprising nine academic centres in France, the investigators systematically analysed risk factors associated with endoscopic recurrence within 6‐12 months of surgical resection for Crohn's disease.…”

Editorial: predicting recurrence of Crohn's disease after surgical resection—Close to a crystal ball. Authors’ reply

“…Dr Singh highlights the importance of optimal risk stratification in the management of Crohn's disease (CD) patients after surgery. In our study, we used early endoscopic recurrence as the primary endpoint . Ileocolonoscopy is recommended within the first year after surgery, since the severity of endoscopic recurrence predicts the clinical course in the following years …”