The History of Postoperative Crohn's Disease Recurrence
The History of Postoperative Crohn's Disease Recurrence
Background Surgical resection of the diseased bowel in Crohn's disease is unfortunately not curative, and postoperative recurrence remains a problem in these patients.
Aim To review the rates of and risk factors for clinical and endoscopic recurrence in population-based studies, referral centres and randomised controlled trials.
Methods We searched MEDLINE (source PUBMED, 1966 to September, 2011).
Results In randomised controlled trials, clinical recurrence in the first year after surgery occurred in 10–38% of patients, whereas endoscopic recurrence in the first year was reported in 35–85% of patients. In population-based studies, approximately half of patients experienced clinical recurrence at 10 years. In referral centres, 48–93% of the patients had endoscopic lesions (Rutgeerts' score ≥1) in the neoterminal ileum within 1 year after surgery, whereas 20–37% had symptoms suggestive of clinical recurrence. Three years after surgery, the endoscopic postoperative recurrence rate increased to 85–100%, and symptomatic recurrence occurred in 34–86% of patients. Smoking is the strongest risk factor for postoperative recurrence, increasing by twofold, the risk of clinical recurrence. Prior intestinal resection, penetrating behaviour, perianal disease and extensive bowel disease (>50 cm) are established risk factors for postoperative recurrence. Risk factors for postoperative recurrence remain poorly defined in population-based cohorts.
Conclusion Endoscopic and clinical postoperative recurrence remains common in patients with Crohn's disease, and the identification of risk factors may allow targeted strategies to reduce this recurrence rate.
Crohn's disease (CD) is a chronic disabling and destructive disease. Despite increased use of immunosuppressive and anti-tumour necrosis factor treatments, approximately half of the patients require surgery within 10 years after diagnosis. Surgical resection of the diseased bowel is not curative, and postoperative recurrence (POR) remains a significant problem in patients with CD. There are numerous studies that report POR in CD; however, these data are heterogeneous and as such difficult to interpret. This review aims to summarise our current knowledge about the incidence of and risk factors for POR in CD. Three types of study design were used for analysis, namely: randomised controlled trials, referral centre studies and population-based studies.
Abstract and Introduction
Abstract
Background Surgical resection of the diseased bowel in Crohn's disease is unfortunately not curative, and postoperative recurrence remains a problem in these patients.
Aim To review the rates of and risk factors for clinical and endoscopic recurrence in population-based studies, referral centres and randomised controlled trials.
Methods We searched MEDLINE (source PUBMED, 1966 to September, 2011).
Results In randomised controlled trials, clinical recurrence in the first year after surgery occurred in 10–38% of patients, whereas endoscopic recurrence in the first year was reported in 35–85% of patients. In population-based studies, approximately half of patients experienced clinical recurrence at 10 years. In referral centres, 48–93% of the patients had endoscopic lesions (Rutgeerts' score ≥1) in the neoterminal ileum within 1 year after surgery, whereas 20–37% had symptoms suggestive of clinical recurrence. Three years after surgery, the endoscopic postoperative recurrence rate increased to 85–100%, and symptomatic recurrence occurred in 34–86% of patients. Smoking is the strongest risk factor for postoperative recurrence, increasing by twofold, the risk of clinical recurrence. Prior intestinal resection, penetrating behaviour, perianal disease and extensive bowel disease (>50 cm) are established risk factors for postoperative recurrence. Risk factors for postoperative recurrence remain poorly defined in population-based cohorts.
Conclusion Endoscopic and clinical postoperative recurrence remains common in patients with Crohn's disease, and the identification of risk factors may allow targeted strategies to reduce this recurrence rate.
Introduction
Crohn's disease (CD) is a chronic disabling and destructive disease. Despite increased use of immunosuppressive and anti-tumour necrosis factor treatments, approximately half of the patients require surgery within 10 years after diagnosis. Surgical resection of the diseased bowel is not curative, and postoperative recurrence (POR) remains a significant problem in patients with CD. There are numerous studies that report POR in CD; however, these data are heterogeneous and as such difficult to interpret. This review aims to summarise our current knowledge about the incidence of and risk factors for POR in CD. Three types of study design were used for analysis, namely: randomised controlled trials, referral centre studies and population-based studies.
Source...