Post-Operative Recurrence of Crohn’s Disease: Impact of Endoscopic Monitoring and Treatment Step-Up
Colorectal Disease, 07/11/2012
De Cruz P et al. – Clinical recurrence occurs in a majority of patients soon after surgery. In this cohort, there was no clinical benefit from colonoscopy or increased drug therapy within one year post–operatively. However, the response to the endoscopic findings was not standardised and immunosuppressive therapy was uncommon. Standardising timing of colonoscopy and drug therapy, including more intense therapy may improve outcome, although this remains to be proven.Methods
- Patients with a bowel resection over a 10 year period were reviewed and comparison made between those who did and did not have a post–operative colonoscopy within one year of surgery, and those who did or did not have a step–up in drug therapy.
- Of 222 operated patients 136 (65 male, mean age 33, mean disease duration 8 years, median follow–up 4 years) were studied.
- Of 70 patients with and 66 without post–operative colonoscopy, clinical recurrence occurred in 49% and 48% (p=NS) and further surgery in 9% and 5% (p=NS).
- Eighty–nine percent of colonoscoped patients had a decision based on the colonoscopic findings.
- Of these, 24% had a step–up of drug therapy [antibiotics (n=10), aminosalicylates (n=2), thiopurine (n=5), methotrexate (n=1),) and 76% had no step–up in drug therapy.
- In colonoscoped patients clinical recurrence occurred in 9 (60%) of 15 patients with, and 23 (49%) of 47 without step up and surgical recurrence in 2 (13%) of 15 and 4 (9%) of 47 (P=NS).