Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease

McLeod, R. S.; Bg, Wolff; Steinhart, A.H.; Carryer, PW; O’Rourke, Keith; Andrews, D. F.; Blair, J.; Cangemi, JR; Cohen, Zane; Cullen, J; Chaytor, RG; Greenberg, Gahl; Jaffer, N. Azeem; Kn, Jeejeebhoy; MacCarty, RL; Ready, RL; Lh, Weiland

doi:10.1016/s0016-5085(97)70001-5

Cited by 93 publications

(41 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Eser

Papay

Primas

et al. 2011

Aliment Pharmacol Ther

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Section: Discussionmentioning

confidence: 99%

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

Eser

Papay

Primas

et al. 2011

Aliment Pharmacol Ther

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“…This endoscopy was not performed routinely, since it is not part of our routine protocols. Moreover, endoscopic recurrence was reported to occur in 72 and 85% of the patients during the first and third years after the operation, respectively [13]. However, this high recurrence rate was dissociated from the clinical course, since only 34% of the patients had a clinical recurrence after 3 years [1, 14].…”

Section: Discussionmentioning

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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“…Percentages vary considerably between studies, mainly due to different populations studied (e.g. referral center vs. population-based cohorts) [6], types of operation (all CD-related surgery vs. only ileocolic resection) and differences in percentages of perceived mild endoscopic disease [7]. Nevertheless, all studies show high recurrence rates.…”

Section: Early Endoscopic and Microscopic Recurrence Of Diseasementioning

confidence: 99%

“…Nevertheless, all studies show high recurrence rates. The postoperative rates of clinical recurrence are lower, although correlating to the extent and severity of endoscopic inflammation observed [3,4,5,7]. However, there can be long-standing disease activity before clinical symptoms appear, and it is not uncommon to find advanced endoscopic lesions in patients who are asymptomatic at presentation.…”

Section: Early Endoscopic and Microscopic Recurrence Of Diseasementioning

confidence: 99%

Management of Postoperative Recurrence of Crohn's Disease

Lent¹,

D’Haens²

2013

Dig Dis

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The course of Crohn's disease (CD) is unpredictable and potentially destructive. The percentage of patients requiring surgery at some stage in their disease accumulates to over 70%. After resection of the affected intestine, reappearance of CD occurs in the majority of patients. Prophylactic medical therapy to reduce the rate of postoperative recurrence has been proven to be effective, yet the incidence of recurrence remains high. Patient profiling (risk stratification) is important in this postoperative setting. High-risk patients (associated with e.g. smoking, the need of repetitive surgery and penetrating disease) require strong immunosuppressive treatment, which should be commenced immediately after surgery, when recurrent disease activity begins. Additionally, early screening endoscopy should be performed to monitor treatment effect. The efficacy of thiopurines is shown to be higher than mesalazine or imidazole antibiotics alone for preventing and ameliorating endoscopic recurrence of CD postoperatively; however, anti-tumor necrosis factors (anti-TNFs) are increasingly considered the most potent agents. In patients with a risk factor for early postoperative recurrence, the first line of treatment is 6-mercaptopurine, in combination with imidazole antibiotics if tolerated, followed by anti-TNFs. When lesions are found at colonoscopy, therapy should be upscaled. We propose a treatment algorithm to direct therapeutic management of CD postoperatively.

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Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease

Cited by 93 publications

References 0 publications

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

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

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

Management of Postoperative Recurrence of Crohn's Disease

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