P417 Crohn disease recurrences: Nothing new under the sun?

Abstract

Over the last 15 years, a multidisciplinary team consisting of gastroenterologists, endoscopists, surgeons, nutritionists, and pathologists for the management of the Crohn disease (CD) patients has been set-up. We designed a dedicated database to analyse whether the biological agents had brought any change in the treatment strategies in CD patients who required a second surgery. We retrospectively reviewed our database from 2000 to 2010 and selected patients with 5 years follow-up who underwent surgery almost once in their life. We collected data about the onset and the follow-up. These patients were divided into four groups according to the medical treatment administered after surgery: patients treated with biologic agents (anti-TNF) (group A), with immunosuppressive drugs (group B), with immunosuppressive and biologic therapy (group C), and with 5-aminosalicylic acid (5-ASA) (group D). Finally, we identified those who received a second surgery and compared the medical treatment, the interval between the two surgeries and the re-operation goal. From 2000 to 2010, 135 patients with CD referred to our Hospital. Among them, 110 patients underwent major surgery at least once in their life: 47 patients were firstly operated in our Tertiary Centre. After surgery, 15 patients were treated with anti-TNF drugs (group A), 22 with immunosuppressive therapy (group B), 36 with biologic and anti-TNF therapy (group C), 37 with 5-ASA (group D). Considering all the groups, 26 patients surgically recurred event though the medical therapy. Patients’ features at the diagnosis 1 and surgical recurrence data are shown in Tables 1 and 2 according to the pre-operative medical treatment. The reasons for re-operations are summarised in Table 3. Currently, none of the available drugs can significantly reduce alone the re-operation incidence for CD. The combined use of immunosuppressive and biologic drugs seems to be the convincing strategy that reasonably delays surgical recurrence, even in high-risk patients. However, our results are biased because of a small sample size along a long period of time.