Rate and risk factors of postoperative endoscopic recurrence of moderate- to high-risk Crohn's disease patients - A real-world experience from a Middle Eastern cohort

Abstract

Background: Crohn's disease (CD) frequently recurs after intestinal resection. Azathioprine (AZA) and biological therapies have shown efficacy in preventing postoperative recurrence (POR). Data on POR from Middle Eastern populations is lacking. This study aimed to evaluate the rate of endoscopic POR in a cohort of CD patients who underwent ileocecal resection (ICR), and to assess the effectiveness of AZA and biological therapies in reducing the risk of disease recurrence. Methods: We performed a retrospective cohort study on 105 CD patients followed at our center, who underwent ileal resection and were at moderate to high risk for POR. Clinical and laboratory data were collected; the primary endpoint was post ICR endoscopic recurrence at 24 months defined by Rutgeerts' score of i2 or more despite treatment. Results: In total, 105 patients with Crohn's disease met our inclusion criteria; 76.2% were in remission and did not have endoscopic POR at 24 months. Further, 41.9% were on biological therapy, and 34.3% were mainly on AZA. Out of the 28.2% who had POR, approximately 15% were on biological therapies. Penetrating phenotype was the only predictive factor for decreasing POR (OR = 0.19, 95% CI: 0.04–0.98, P = 0.04) as identified in multiple logistic regression analysis. Conclusions: The use of biological therapies post-surgery was not superior than AZA in reducing the endoscopic POR for mod- high risk CD patients. Only penetrating behavior of the CD was associated with significantly lower risk of endoscopic recurrence. This finding is worth further investigation in more robust study designs and among larger samples of patients.

Risk factors for endoscopic postoperative recurrence in patients with Crohn’s Disease: a protocol for systematic review and meta-analysis

“…Of the 22 articles, 12 were from Europe [ 13 , 18 – 20 , 22 – 25 , 30 , 36 ], 4 from North America [ 21 , 26 , 27 , 29 ], 5 from Asia [ 14 , 15 , 28 , 34 , 35 ], and 1 from South America [ 17 ]. The results demonstrated that the ePOR rate was [ES = 0.55, 95% CI (0.47, 0.63)] in Europe, [ES = 0.24, 95% CI (0.13, 0.35)] in North America, [ES = 0.53, 95% CI (0.32, 0.73)] in Asia, and [ES = 0.34, 95% CI (0.26, 0.42)] in South America.…”

“…Of the included 23 studies published from 2015 to 2023, 5 were case-control studies [13][14][15][16][17] and 18 were cohort studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Among them, 3 were from the Netherlands [19,20,33], 3 each from Italy [13,23,24] and China [15,28,31], 4 each from France [18,25,30,32] and the United States [21,26,27,29], and 1 each from Korea [14], Belgium [22], Portugal [16], Japan [34], Israel [35], and Brazil [17].…”

Timing of individualized surgical intervention in Crohn’s disease

“…Azathioprine is commonly used as an immunosuppressant for treating CD and may not increase the risk of postoperative complications. Although azathioprine has demonstrated efficacy in preventing postoperative recurrence, there is no significant decrease in the need for surgery or intestinal complications from CD[ 71 , 72 ] (Table 1 ). Furthermore, CD patients are frequently treated with steroids before surgery.…”

Erratum: Rate and risk factors of postoperative endoscopic recurrence of moderate- to high-risk Crohn’s disease patients - A real-world experience from a Middle Eastern cohort

“…In the article titled “Rate and risk factors of postoperative endoscopic recurrence of moderate- to high-risk Crohn’s disease patients - A real-world experience from a Middle Eastern cohort”, published on pages 201-208, Issue 3, Volume 28, of Saudi Journal of Gastroenterology [ 1 ], the affiliation for authors “Nahla Azzam, Abdulla Al Thaher, Othman Alharbi, Mansour Altuwaijri, Suliman Alshankiti, Mohammed Alanazi, Abdulelah Alanazi and Abdulrahman Aljebreen, is incorrectly written as “Department of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia.”…”