Abstract
Purpose
We evaluated the effect of potential clinical factors on surgical recurrence of ileal Crohn’s disease after initial ileocolic resection.
Methods
One hundred seventy-six patients with ileal Crohn’s disease who underwent an ileocolic resection with anastomosis were identified from our database. The outcome of interest was time from first to second ileocolic resection. Survival analysis was used to assess the significance of the Montreal phenotype classification, smoking habit, a family history of inflammatory bowel disease and other clinical variables.
Results
In our final Cox model, a family history of inflammatory bowel disease (hazard ratio 2.24, 95 percent confidence interval 1.16–4.30, P = 0.016), smoking at time of initial ileocolic resection (hazard ratio 2.08, 95 percent confidence interval 1.11–3.91, P = 0.023) was associated with an increased risk of a second ileocolic resection while postoperative prescription of immunomodulators (hazard ratio 0.40, 95 percent confidence interval 0.18–0.88, P = 0.022) was associated with a decreased risk of a second ileocolic resection.
Conclusions
Both a family history of inflammatory bowel disease and smoking at the time of the initial ileocolic resection are associated with an increased risk of a second ileocolic resection. Postoperative prescription of immunomodulators is associated with a reduced risk of surgical recurrence. This study supports the concept that both genetic and environmental factors influence the risk of surgical recurrence of ileal Crohn’s disease.
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References
Farmer RG, Whelan G, Fazio VW. Long-term follow-up of patients with CD. Relationship between the clinical pattern and prognosis. Gastroenterology 1985;88:1818–25.
Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal CD. Br J Surg 2000;87:1697–701.
Strong SA, Koltun WA, Hyman NH, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the surgical management of Crohn’s disease. Dis Colon Rectum 2007;50:1735–46.
Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of CD. Gastroenterology 1990;99:956–63.
Lock MR, Farmer RG, Fazio VW, Jagelman DG, Lavery IC, Weakley FL. Recurrence and reoperation for CD. N Engl J Med 1981;304:1586–88.
Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006;55:749–53.
Goyette P, Labbé C, Trinh TT, Xavier RJ, Rioux JD. Molecular pathogenesis of inflammatory bowel disease: genotypes, phenotypes and personalized medicine. Ann Med 2007;39:177–99.
Cho JH, Weaver CT. The genetics of inflammatory bowel disease. Gastroenterology 2007;133:1327–39.
Xavier RJ, Podolsky DK. Unravelling the pathogenesis of inflammatory bowel disease. Nature 2007;448:427–34.
Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 2004;126:1504–17.
Sutherland LR, Ramcharan S, Bryant H, Fick G. Effects of cigarette smoking on recurrence of CD. Gastroenterology 1990;98:1123–8.
Cottone M, Rosselli M, Orlando A, et al. Smoking habits and recurrence in CD. Gastroenterology 1994;106:643–8.
Moskovitz D, McLeod RS, Greenberg GR, Cohen Z. Operative and environmental risk factors for recurrence of CD. Int J Colorectal Dis 1999;14:224–6.
Yamamoto T, Keighley MR. The association of cigarette smoking with a high risk of recurrence after ileocolonic resection for ileocecal CD. Surg Today 1999;29:579–80.
Ryan WR, Allan RN, Yamamoto T, Keighley MR. CD patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg 2004;187:219–25.
Kane SV, Flicker M, Katz-Nelson F. Tobacco use is associated with accelerated clinical recurrence of CD after surgically induced remission. J Clin Gastroenterol 2005;39:32–5.
Lowney JK, Dietz DW, Birnbaum EH, Kodner IJ, Mutch MG, Fleshman JW. Is there any difference in recurrence rates in laparoscopic ICR for CD compared with conventional surgery? A long-term, follow-up study. Dis Colon Rectum 2006;49:58–63.
Tan JJ, Tjandra JJ. Laparoscopic surgery for CD: a meta-analysis. Dis Colon Rectum. 2007;50:576–85.
Hanauer SB, Korelitz BI, Rutgeerts P, et al. Postoperative maintenance of CD remission with 6-mercaptopurine, mesalamine, or placebo: a 2-year trial. Gastroenterology 2004;127:723–9.
Ardizzone S, Maconi G, Sampietro GM, et al. Azathioprine and mesalamine for prevention of relapse after conservative surgery for CD. Gastroenterology. 2004;127:730–40.
Vermeire S, van Assche G, Rutgeerts P. Altering the natural history of CD-evidence for and against current therapies. Aliment Pharmacol Ther 2007;25:3–12.
Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J. Behaviour of CD according to the Vienna classification: changing pattern over the course of the disease. Gut 2001;49:777–82.
Chardavoyne R, Flint GW, Pollack S, Wise L. Factors affecting recurrence following resection for CD. Dis Colon Rectum 1986;29:495–502.
Aldhous MC, Drummond HE, Anderson N, Smith LA, Arnott ID, Satsangi J. Does cigarette smoking influence the phenotype of CD? Analysis using the Montreal classification. Am J Gastroenterol 2007;102:577–88.
Burke JP, Mulsow JJ, O’Keane C, Docherty NG, Watson RW, O’Connell PR. Fibrogenesis in CD. Am J Gastroenterol 2007;102:439–48.
Lichtenstein GR, Olson A, Travers S, et al. Factors associated with the development of intestinal strictures or obstructions in patients with CD. Am J Gastroenterol 2006;101:1030–8.
Acknowledgments
This authors thank the patients who have contributed their medical information to the Digestive Diseases Research Core Center (DDRCC) Clinical Database, Michael Lewis and Drs. Elisa Birnbaum, James Fleshman, Ira Kodner, Jennifer Lowney, Matthew Mutch in the Section of Colon and Rectal Surgery, Drs. Matthew Ciorba, Ray Clouse, Nicholas Davidson, Dayna Early, Chandra Prakash, Deborah Rubin and William Stenson in the Division of Gastroenterology at Washington University, and Dr. Robert Rothbaum in the Division of Pediatric Gastroenterology and Nutrition at Washington University for their help and support in recruiting patients, the community gastroenterologists including Drs. Barry Abramson, Marc Bernstein, Paul Buse, David Cort, Steve Fern, John J. Kelly, Carl Lyss, Robert Shuman, Eric Thyssen, Janet Todorczuk, David Walden, Michele Woodley, Leonard Weinstock, Michael Zerega for their help and support in recruiting patients, and Dr. David Alpers for helpful discussions and suggestions in preparing this manuscript.
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This work was supported in part by NIH grant P30 DK52574 (Li), Barnes Jewish Foundation Grant 00434–0805–01 (Dietz/Hunt), Johnson and Johnson Translational Seed Award (Li). L.A. was supported by T35 DK074375.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 7, 2007.
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Unkart, J.T., Anderson, L., Li, E. et al. Risk Factors for Surgical Recurrence after Ileocolic Resection of Crohn’s Disease. Dis Colon Rectum 51, 1211–1216 (2008). https://doi.org/10.1007/s10350-008-9348-7
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DOI: https://doi.org/10.1007/s10350-008-9348-7