Postoperative Crohn’s disease, recurrence rate and risk factors.

Jaspers, S. (Sophie) (2014) Postoperative Crohn’s disease, recurrence rate and risk factors. thesis, Medicine.

Text JaspersS.pdf Restricted to Registered users only Download (555kB)

Abstract

Background and aims: Despite advances in medical management, many patients with Crohn’s disease (CD) require intestinal surgery during the course of the disease. Surgery is not a cure and postoperative recurrence is common in patients with CD. Ileocolonoscopy is the gold standard in the diagnosis of postoperative recurrence. There are numerous studies that report numbers of postoperative recurrence, but with varying results. Also previous studies that focus on risk factors for postoperative recurrence have given inconclusive results. The aim of this study was to retrospectively determine the endoscopic and symptomatic recurrence rate as well as to identify risk factors. Materials and methods: We conducted a retrospective cohort study including 156 patients with CD who underwent an ileocecal resection between 2008 and 2013 in two referral centres. Symptomatic recurrence rates in this group were calculated. Of these, 105 patients had undergone an ileocolonoscopy within two years postoperatively and in this group endoscopic recurrence rates were calculated. To identify risk factors for endoscopic recurrence, data were compared between recurrence (modified Rutgeerts score ≥i2b) and no recurrence (modified Rutgeerts score <i2b). We also compared data to identify risk factors for symptomatic recurrence. Clinical phenotypes were classified according to the Montreal classification (age at diagnosis, location of disease and disease behaviour). Gender, family history of inflammatory bowel disease (IBD), smoking behaviour, history of previous resection(s), surgery indication, type of anastomosis, ileum length resected and postoperative use of medication were analysed as possible risk factors. Results: In 105 patients, the overall endoscopic recurrence rate was 38.1%, whereas the symptomatic recurrence rate was 17.1% (in 156 patients). The endoscopic recurrence rate in patients who used postoperative biologics was 26.3%, 23.8% in patients who used immunomodulators and 51.9% in patients without postoperative medication. Only smoking the year before surgery (OR; 3.590, 95% CI 1.269-10.233, p=0.017) seemed to be a significant risk factor in the multivariate analysis for risk factors for endoscopic recurrence. Postoperative use of medication was a protective factor (not significant, but a trend), which reduced the risk with 63.1%. In the multivariate analysis for recurrence, smoking the year before surgery (OR; 3.809, 95% CI 1.346-10.781, p=0.012) and disease behaviour (OR; 4.777, 95% CI 1.206-18.920, p=0.026) appeared to be significant risk factors. Also medication was a protective factor (OR; 0.215, 95% CI 0.071-0.658, p=0.007). Conclusion: This retrospective multicentre cohort study is the first study that used the modified Rutgeerts score to evaluate endoscopic recurrence. The endoscopic as well as the symptomatic recurrence rates found were both lower than in previous studies. Prospective studies are indicated to evaluate the endoscopic recurrence rate (with the modified Rutgeerts score), to make sure every patient will undergo an ileocolonoscopy (at the same time) and thus have an even more reliable result. Based on our study, special attention should be paid in the postoperative phase to patients with smoking habits. An early start with immunomodulators or antitumor necrosis factor (TNF) therapy among these patients should be taken into consideration.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijholt, I.M.
Supervisor name:	Duijvestein, dr. M. and D’Haens, Prof. Dr. G.R.A.M. and Academic Medical Centre (AMC), Amsterdam
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:50
Last Modified:	25 Jun 2020 10:50
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1120

Actions (login required)

View Item