Natural course of Crohn's disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms.

Abstract

Forty two Crohn's disease patients were followed up after ileocolic resection with regard to symptoms and endoscopic appearance of the ileocolic anastomosis. Twenty eight patients resected because of colonic neoplasm served as controls. In all the Crohn's disease patients the ileal resection margin was disease free macroscopically at operation. In addition, intraoperative ileoscopy was performed in 13 and no sign of residual inflammation in the neoterminal ileum was seen. Endoscopy soon after surgery often showed preanastomotic ileal ulceration before symptoms appeared, whereas no anastomotic lesions were observed in the controls. Thus, 22 of 30 Crohn's disease patients examined had ulceration of the anastomotic area after three months, but only 10 had developed symptoms indicating relapse (73 v 33%). Corresponding figures in the 30 patients examined after one year were 93 v 37%, and in 14 patients after three years they were 100 and 86% respectively. The inflammatory lesions in all cases were preanastomotic, in the neoterminal ileum, and showed time related progression from aphthae to larger ulcers and stricture. The study suggests that endoscopically observed inflammatory lesions that appear soon after ileocolic resection for Crohn's disease signify new inflammation and not residual, persistent disease or incomplete anastomotic healing. The data further suggest that despite clinical remission after apparently radical intestinal resection, the bowel is permanently inflamed in Crohn's disease.

The impact of intestinal resection on serum levels of anti‐Saccharomyces cerevisiae antibodies (ASCA) in patients with Crohn’s disease

“…A clinical relapse follows in 34% of patients within 3 years after major surgery. [4][5][6] So far, particularly the assessment of post-operative endoscopic lesions is used to predict the risk of relapse. 6 In CD, anti-Saccharomyces cerevisiae antibodies (ASCA) of the isotypes IgG or IgA have been demonstrated in sera of 60-70% of patients, particularly in those with ileal involvement.…”

Evolving Inflammatory Bowel Disease Treatment Paradigms: Top-Down Versus Step-Up

“…Within a year after intestinal resection, at least 70% of patients have recurrent disease endoscopically, yet clinical recurrence occurs in only one-third by 3 years, implying that endoscopic lesions and symptoms may not correlate. [87][88][89][90] A recent study, presented in abstract form, demonstrated that determination of the clinical impression of disease activity had a sensitivity and specificity of only 56.4% and 80.9%, respectively when compared with colonoscopy as the gold standard. 91 In clinical trials of mesalamine and infliximab for UC, endoscopic healing has been demonstrated to exceed the proportion of patients meeting criteria for clinical improvement or remission, emphasizing that noninflammatory processes can drive symptoms in IBD.…”

Resección ileocecal por enfermedad de Crohn: Resultados y seguimiento

“…El porcentaje de recurrencia es aún mayor, al realizar un seguimiento a más de 10 años desde la operación 21 . Olaison et al 22 , reportó un seguimiento endoscópico a los pacientes sometidos a RIC por EC en el cual observó una recurrencia de 93% a un año de la operación. En nuestra serie los dos casos de recidiva intestinal fueron operados.…”