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Incidence and Management of Recurrence in Patients with Crohn's Disease Who Have Undergone Intestinal Resection: The Practicrohn Study

Domènech, Eugeni MD, PhD1; Garcia, Valle MD, PhD2; Iborra, Marisa MD3; Gutiérrez, Ana MD, PhD4; García-López, Santiago MD, PhD5; Martín Arranz, María D. MD, PhD6; Garcia-Planella, Esther MD7; Calvo, Marta MD8; Castro, Luisa MD9; Mínguez, Miguel MD10; Taxonera, Carlos MD, PhD11; Juliá, Berta MD12; Cea-Calvo, Luis MD12; Romero, Cristina PharmD12; Barreiro-de Acosta, Manuel MD, PhD13

doi: 10.1097/MIB.0000000000001180
Original Clinical Articles

Background: More than 50% of patients with Crohn's disease require intestinal resection at least once. Postoperative recurrence (POR) is almost uniform if prophylactic treatment is not started early. Endoscopic monitoring is generally advised. We studied the incidence and management of recurrence in patients who had undergone intestinal resection.

Methods: Practicrohn was an observational retrospective study performed in 26 Spanish hospitals including patients aged ≥18 years who underwent Crohn's disease–related ileocolonic resection between January 2007 and December 2010. We recorded preventive treatments, the incidence of clinical recurrence in daily practice, and associated risk factors.

Results: The study population comprised 314 patients. Median (interquartile range) time from diagnosis to surgery was 6 (1–12) years. Prophylaxis for POR was administered to 208 patients (68%). Endoscopy was performed in 143 (46%) patients the first year after surgery. Clinical POR was detected in 97 patients (31%) after a median 315 (65–748) days. The cumulative probability of clinical POR was 16%, 27%, and 31% at 1, 3, and 5 years, respectively, being higher among patients not receiving immunomodulators as compared to those who received prophylaxis (P = 0.014). Forty-five patients (14%) required reoperation at 5 years after a median time from the first intervention of 228 (133–527) days.

Conclusions: In this real-life study, up to one-third of patients with Crohn's disease did not start preventive therapy after intestinal resection, and almost half of them were not endoscopically monitored as recommended. In this setting, 30% of patients developed clinical POR within the first 5 years after surgery, thus indicating that there is room for improvement.

Article first published online 20 june 2017.

1Servicio de Aparato Digestivo Hospital Universitari Germans Trias i Pujol and CIBERehd, Badalona, Spain;

2Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain;

3Servicio de Gastroenterologia, Hospital La Fe, Valencia, Spain;

4Servicio Medicina Digestiva Hospital General Universitario de Alicante y CIBEREHD Instituto de Salud Carlos III, Madrid, Spain;

5Servicio de Gastroenterología, Hospital Universitario Miguel Servet, Zaragoza, Spain;

6Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain, IdiPaz;

7Servicio de Patología Digestiva Hospital de la Santa Creu y Sant Pau, Barcelona, Spain;

8Servicio de Gastroenterología, Hospital Puerta de Hierro, Madrid, Spain;

9Unidad de Gastroenterología Hospital Virgen Macarena, Sevilla, Spain;

10Servicio de Medicina Digestiva Hospital Clínico de Valencia, Universitat de Valencia;

11Servicio de Gastroenterología, Hospital Clínico San Carlos, Madrid, Spain;

12Departamento médico MSD, Madrid, Spain; and

13Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.

Address correspondence to: Berta Juliá, MD, Departamento médico MSD, 28027 Madrid, Spain (e-mail: berta_julia@merck.com).

Supported by MSD, Spain.

Author disclosures are available in the Acknowledgments.

Editorial assistance was provided by Content Ed Net, Madrid, Spain.

Received February 09, 2017

Accepted April 25, 2017

© Crohn's & Colitis Foundation
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