Abstract
Background Postoperative endoscopic recurrence (PER) is common in patients with Crohn's disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear. Methods The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. Colonoscopies were performed within one year after surgery. Clinical data and risk factors for endoscopic recurrence were analyzed focusing on postoperative pharmacological prophylaxis. Results All patients were at a high risk of postoperative recurrence according to the AGA guidelines. PER occurred in 29 (28.7%) of these patients. The overall PER rate was 39.2% at one year. The PER rate in patients treated with nitroimidazole, thiopurines, infliximab, or a combination of thiopurines and infliximab for postoperative prophylaxis was 88.1%, 34.1%, 20.5%, and 0%, respectively. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, P = 0.01; HR: 0.36, 95% CI: 0.15-0.86, P = 0.02). In addition, further investigation revealed that educational background was the main factor related to patients' nonadherence to AGA guidelines. Conclusions The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Thiopurines and infliximab are effective in preventing endoscopic recurrence. Guideline nonadherence is associated with PER at one year, thus indicating that there is room for improvement in adherence to the AGA guidelines.
Highlights
Crohn’s disease (CD) is an idiopathic, chronic, relapsing, and formidable inflammatory disease that could affect the whole gastrointestinal tract, but the disease is predisposed to the ileocolon [1, 2]
Emerging research conducted by the American Gastroenterological Association (AGA) showed several risk factors, such as active smoking, age less than 30 years, and prior surgeries for penetrating disease, with or without perianal disease, that are correlated with postoperative recurrence [9]
A total of 129 patients underwent ileocolonic resection with primary or secondary anastomosis for CD between January 2017 and June 2018, but only 101 of patients participated in endoscopic monitoring within one year after surgery
Summary
Crohn’s disease (CD) is an idiopathic, chronic, relapsing, and formidable inflammatory disease that could affect the whole gastrointestinal tract, but the disease is predisposed to the ileocolon [1, 2]. Emerging research conducted by the American Gastroenterological Association (AGA) showed several risk factors, such as active smoking, age less than 30 years, and prior surgeries for penetrating disease, with or without perianal disease, that are correlated with postoperative recurrence [9]. The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. All patients were at a high risk of postoperative recurrence according to the AGA guidelines. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, P = 0:01; HR: 0.36, 95% CI: 0.15-0.86, P = 0:02). The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Guideline nonadherence is associated with PER at one year, indicating that there is room for improvement in adherence to the AGA guidelines
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