Mo1250 Cytomegalovirus (CMV) and Epstein Barr Virus (EBV) Specific ELISPOT Assays Detect Frequent Reactivation of CMV and EBV in Inflammatory Bowel Disease

Background: Most patients with Crohn's disease (CD) will undergo at least one intestinal resection during the course of their disease.Postoperative endoscopic recurrence is reported to occur in 60-80% of patients within 1 year.The utility of postoperative medical prophylaxis and the treatment of mild endoscopic recurrence continue to be debated in the literature.Aims: To document rates and predictors of endoscopic and clinical recurrence after primary ileocolic resection for CD in a large, tertiary academic center.Methods: We performed a retrospective chart review on patients who underwent primary ileocolic resection for CD between 1991 and 2010 at our institution.Only patients with clinical follow-up including postoperative endoscopic assessment at our institution were included in our analysis.Details of preoperative disease behavior, medication history, surgical pathology, and postoperative endoscopic, radiologic, and clinical course were recorded.Endoscopic recurrence (ER) was defined using the Rutgeerts score (RS) where RS ≥ 1 indicated ER.Clinical recurrence (CR) was defined as symptoms of CD with endoscopic or radiologic evidence of neo-terminal ileal disease.Results: 171 patients met inclusion criteria (median age at diagnosis 22 years, 50% male; 19% current smokers).66 patients (39%) received postoperative medical prophylaxis.The cumulative probability of ER (RS ≥ 1) at 1, 2 and 5 years was: 29%, 51% and 77%, respectively.In a multivariate model, the only independent predictors of ER were the absence of postoperative medical prophylaxis (HR 1.5; 95% CI, 1.1-2.2;P = 0.03) and penetrating disease behavior (HR 1.5; 95% CI, 1.0-2.1;P = 0.05).In patients not receiving postoperative medical prophylaxis, perianal disease was associated with ER (HR 1.7; P = 0.05).The cumulative probability of CR at 1, 2 and 5 years was: 8%, 13% and 27%, respectively.In a multivariate model, the only independent predictors of CR were perioperative smoking (HR 2.3; 95% CI, 1.3-4.0;P < 0.01) and preoperative upper gastrointestinal tract involvement (HR 4.0; 95% CI, 1.8-8.3;P < 0.001).There was a higher rate of clinical recurrence in patients with RS-2 compared to RS-1 on endoscopy (HR 2.5; 95% CI, 1.2-5.9;P = .02).Conclusions: Rates of early ER in this cohort are less than previously reported in the literature.Postoperative medical prophylaxis did decrease the likelihood of ER while certain phenotypes of CD appear to increase the risk of developing ER and CR.The majority of patients with ER did not develop CR, which may reflect the increasing use of postoperative endoscopic surveillance that can facilitate early treatment of ER prior to the evolution of clinical symptoms.Survival free of endoscopic recurrence after primary ileocolic resection for Crohn's disease.