Introduction: The incidence of endoscopic recurrence (ER) in Crohn's disease following curative resection is up to 75% at 1. year. Endoscopy is the most sensitive method to detect the earliest mucosal changes and the severe ER at 1. year seems to predict a clinical relapse. Methods: The aim of this prospective study was to evaluate the incidence of early ER 6. months after curative resection. Secondary outcome was to evaluate the role of 5-aminosalicylic acid (5-ASA) in the prevention of ER at 6. months. A total of 170 patients were included in the study. They were carried-out from the evaluation of the appearance of ER during a trial performed to assess the role of azathioprine vs. 5-ASA as early treatment of severe ER. All the patients started 5-ASA treatment 2. weeks after surgery. Results: Six months after surgery ER was observed in 105 patients (62%). The endoscopic score was reported as severe in 78.1% of them (82 out of 105). At univariable analysis only ileo-colonic disease influenced the final outcome associating to a lower risk of severe ER (p. =. 0.04; OR 0.52, 95% CI 0.277-0.974). Conclusion: In this prospective Italian multicenter IG-IBD study a great proportion of ER occur within 6. months from ileo-colonic resection, with a significant rate of severe ER. Furthermore this study confirms the marginal role of 5-ASA in the prevention of ER. This suggests that post-surgical endoscopic evaluation should be performed at 6. months instead of 1. year to allow an adequate early treatment.

Early post-operative endoscopic recurrence in Crohn's disease patients: Data from an Italian Group for the study of inflammatory bowel disease (IG-IBD) study on a large prospective multicenter cohort

Onali S.;
2014-01-01

Abstract

Introduction: The incidence of endoscopic recurrence (ER) in Crohn's disease following curative resection is up to 75% at 1. year. Endoscopy is the most sensitive method to detect the earliest mucosal changes and the severe ER at 1. year seems to predict a clinical relapse. Methods: The aim of this prospective study was to evaluate the incidence of early ER 6. months after curative resection. Secondary outcome was to evaluate the role of 5-aminosalicylic acid (5-ASA) in the prevention of ER at 6. months. A total of 170 patients were included in the study. They were carried-out from the evaluation of the appearance of ER during a trial performed to assess the role of azathioprine vs. 5-ASA as early treatment of severe ER. All the patients started 5-ASA treatment 2. weeks after surgery. Results: Six months after surgery ER was observed in 105 patients (62%). The endoscopic score was reported as severe in 78.1% of them (82 out of 105). At univariable analysis only ileo-colonic disease influenced the final outcome associating to a lower risk of severe ER (p. =. 0.04; OR 0.52, 95% CI 0.277-0.974). Conclusion: In this prospective Italian multicenter IG-IBD study a great proportion of ER occur within 6. months from ileo-colonic resection, with a significant rate of severe ER. Furthermore this study confirms the marginal role of 5-ASA in the prevention of ER. This suggests that post-surgical endoscopic evaluation should be performed at 6. months instead of 1. year to allow an adequate early treatment.
2014
5-Aminosalicylic acid
Crohn's disease
Endoscopic recurrence
Severe recurrence
Adult
Anti-Inflammatory Agents, Non-Steroidal
Colonoscopy
Crohn Disease
Female
Humans
Italy
Male
Mesalamine
Middle Aged
Postoperative Period
Prospective Studies
Recurrence
Severity of Illness Index
Time Factors
Young Adult
File in questo prodotto:
File Dimensione Formato  
orlando jcc 2014.pdf

accesso aperto

Descrizione: Articolo principale
Tipologia: versione editoriale
Dimensione 202.13 kB
Formato Adobe PDF
202.13 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11584/301734
Citazioni
  • ???jsp.display-item.citation.pmc??? 11
  • Scopus 49
  • ???jsp.display-item.citation.isi??? 49
social impact