Clinical Predictors of Early and Late Endoscopic Recurrence Following Ileocolonic Resection in Crohn’s Disease

医学 结肠镜检查 克罗恩病 优势比 置信区间 内科学 外科 胃肠病学 疾病 风险因素 结直肠癌 癌症
作者
Cristian Hernández-Rocha,Margaret Walshe,Sondra Birch,Ksenija Sabic,Ujunwa Korie,Colleen Chasteau,Vessela Miladinova,William B Sabol,Emebet Mengesha,Mary Hanna,Valeriya Pozdnyakova,Lisa W. Datta,Rita Kohen,Raquel Milgrom,Joanne M. Stempak,Alain Bitton,Steven R. Brant,John D. Rioux,Dermot McGovern,Richard J. Grand,Judy H. Cho,L. Philip Schumm,Mark S. Silverberg,Mark Lazarev
出处
期刊:Journal of Crohn's and Colitis [Oxford University Press]
卷期号:18 (4): 615-627 被引量:5
标识
DOI:10.1093/ecco-jcc/jjad186
摘要

Abstract Background and Aims Multiple factors are suggested to place Crohn’s disease patients at risk of recurrence after ileocolic resection with conflicting associations. We aimed to identify clinical predictors of recurrence at first [early] and further [late] postoperative colonoscopy. Methods Crohn’s disease patients undergoing ileocolic resection were prospectively recruited at six North American centres. Clinical data were collected and endoscopic recurrence was defined as Rutgeerts score ≥i2. A multivariable model was fitted to analyse variables independently associated with recurrence. Results A total of 365 patients undergoing 674 postoperative colonoscopies were included with a median age of 32 years, 189 [51.8%] were male, and 37 [10.1%] were non-Whites. Postoperatively, 133 [36.4%] used anti-tumour necrosis factor [anti-TNF] and 30 [8.2%] were smokers. At first colonoscopy, 109 [29.9%] had recurrence. Male gender (odds ratio [OR] = 1.95, 95% confidence interval [CI] 1.12–3.40), non-White ethnicity [OR = 2.48, 95% CI 1.09–5.63], longer interval between surgery and colonoscopy [OR = 1.09, 95% CI 1.002–1.18], and postoperative smoking [OR = 2.78, 95% CI 1.16–6.67] were associated with recurrence, while prophylactic anti-TNF reduced the risk [OR = 0.28, 95% CI 0.14–0.55]. Postoperative anti-TNF prophylaxis had a protective effect on anti-TNF experienced patients but not on anti-TNF naïve patients. Among patients without recurrence at first colonoscopy, Rutgeerts score i1 was associated with subsequent recurrence [OR = 4.43, 95% CI 1.73–11.35]. Conclusions We identified independent clinical predictors of early and late Crohn’s disease postoperative endoscopic recurrence. Clinical factors traditionally used for risk stratification failed to predict recurrence and need to be revised.
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