Postoperative Recurrence Of Crohn Research Articles

49 P Virtual colonoscopy for the assessment of postoperative recurrence in Crohn's disease

49 P Virtual colonoscopy for the assessment of postoperative recurrence in Crohn's disease

37 P Mesalazine in the prevention of clinical and endoscopic postoperative recurrence of Crohn's disease: A meta-analysis

37 P Mesalazine in the prevention of clinical and endoscopic postoperative recurrence of Crohn's disease: A meta-analysis

30 OC Ciprofloxacin versus mesalazine in the prevention of postoperative recurrence of Crohn's disease: Preliminary results

30 OC Ciprofloxacin versus mesalazine in the prevention of postoperative recurrence of Crohn's disease: Preliminary results

Changes in the bacterial flora of the neoterminal ileum after ileocolonic resection for Crohn’s disease

OBJECTIVE: Bacterial agents have been implicated in the early recurrence of Crohn’s disease after ileocolectomy. The aim of our study was to identify and quantify bacteria associated with the ileal mucosa in patients and controls and to correlate specific bacteria with recurrence. METHODS: The predominant bacterial microflora of the ileum were enumerated and identified, aerobically and anaerobically, in biopsies obtained at the time of surgery or by endoscopy from 61 patients with Crohn’s disease and 10 ileocolectomy controls. The 61 specimens were comprised of 13 ileal biopsies taken from resection specimens, seven taken after ileostomy, and 41 taken after ileocolectomy. RESULTS: Ileocolectomy induced a significant increase in bacterial counts and variety in the neoterminal ileum in both patients and controls that was not observed in ileostomy biopsies. Comparison between patients and controls revealed greater numbers of Escherichia coli and enterococci in Crohn’s disease and of bifidobacteria and ruminococci in controls. Early recurrence was associated with high counts of E. coli and bacteroides and the frequent isolation of fusobacteria. CONCLUSION: After ileocolectomy, colonization of the neoterminal ileum is increased. Our data suggest that increases in the populations of specific bacteria such as E. coli, enterococci, bacteroides, and fusobacteria may be important in postoperative recurrence of Crohn’s disease.

Changes in the bacterial flora of the neoterminal ileum after ileocolonic resection for Crohn's disease.

Bacterial agents have been implicated in the early recurrence of Crohn's disease after ileocolectomy. The aim of our study was to identify and quantify bacteria associated with the ileal mucosa in patients and controls and to correlate specific bacteria with recurrence. The predominant bacterial microflora of the ileum were enumerated and identified, aerobically and anaerobically, in biopsies obtained at the time of surgery or by endoscopy from 61 patients with Crohn's disease and 10 ileocolectomy controls. The 61 specimens were comprised of 13 ileal biopsies taken from resection specimens, seven taken after ileostomy, and 41 taken after ileocolectomy. Ileocolectomy induced a significant increase in bacterial counts and variety in the neoterminal ileum in both patients and controls that was not observed in ileostomy biopsies. Comparison between patients and controls revealed greater numbers of Escherichia coli and enterococci in Crohn's disease and of bifidobacteria and ruminococci in controls. Early recurrence was associated with high counts of E. coli and bacteroides and the frequent isolation of fusobacteria. After ileocolectomy, colonization of the neoterminal ileum is increased. Our data suggest that increases in the populations of specific bacteria such as E. coli, enterococci, bacteroides, and fusobacteria may be important in postoperative recurrence of Crohn's disease.

Azathioprine for prevention of postoperative recurrence in Crohn's disease: a retrospective study.

The efficacy of azathioprine (AZA) in chronically active Crohn's disease (CD) is well established. Whether this drug is also useful to prevent recurrences after surgery is unknown. We report here our experience of AZA in this therapeutic goal. Between 1987 and 1996, 38 patients with CD were treated with AZA to prevent postoperative recurrence. Twenty-three of these had undergone a curative resection with removal of all previously involved parts of the gut. In the other 15 patients, resection was limited to the parts of the gut macroscopically abnormal at the time of surgery; those parts that were previously involved but normal at this time were conserved. The operative procedures were ileocolonic resection (n = 18), subtotal colectomy with ileorectal anastomosis (n = 12), coloproctectomy with ileo-anal anastomosis (n = 4) or ileostomy (n = 2), ileal resection (n = 1) and segmental colectomy (n = 1). Twelve patients had been treated previously with AZA before surgery; in 26 patients, AZA was started within the 2 months following surgery. The median duration of postoperative follow-up was 29 months. Probabilities of clinical recurrence according to the Kaplan-Meier method were 9, 16 and 28% at 1, 2 and 3 years, respectively. For the 25 patients who had a colonoscopy or a small bowel barium X-ray during the follow-up, probabilities of anatomical recurrence were 16, 36 and 59% at 1, 2 and 3 years, respectively. The probability of anatomical recurrence was significantly higher in patients who had segments of the gut previously involved but not removed because they were macroscopically normal at the time of surgery. In patients treated with AZA, the rate of postoperative endoscopic recurrence was lower than that previously reported in untreated patients. Our results suggest that AZA should be evaluated prospectively for prevention of postoperative CD recurrence, at least in high-risk patients.

Two mesalazine regimens in the prevention of postoperative recurrence of Crohn's disease: A double blind randomised clinical trial. a GISC study

Two mesalazine regimens in the prevention of postoperative recurrence of Crohn's disease: A double blind randomised clinical trial. a GISC study

5-amino-salicylate in the management of inflammatory bowel disease.

The role of aminosalicylates in the treatment of idiopathic bowel disease is reviewed, with emphasis on how the different formulations can be used in different clinical manifestations. Although not fully understood, the possible mechanisms of action of these agents are discussed and their adverse reactions noted. Their use in clinical practice, both in acute disease and in remission, is outlined with particular reference to the different delivery characteristics of the aminosalicylates, thus allowing their use according to the distribution of the disease. Finally, benefits that might come from maintenance therapy, including possible reduction in post-operative recurrence of Crohn's disease and the risk of colorectal cancer are mentioned.

Pediatric Crohn’s disease: risk factors for postoperative recurrence

OBJECTIVE: Postoperative recurrence of Crohn’s disease in adults has been extensively studied; however, the course of Crohn’s disease after surgery in children has not been well defined. The aim of this study was to examine the postoperative course of pediatric Crohn’s disease and the factors that may predict early postoperative recurrence. METHODS: We identified 100 resective surgeries in 79 children with Crohn’s disease seen at the Children’s Hospital of Philadelphia between 1978 and 1996. A retrospective, multivariable analysis of factors potentially influencing postoperative clinical recurrence was performed. Preoperative and postoperative height measurements were compared, and z scores were computed for height-for-age. Two-tailed t test was used for the analysis. RESULTS: Clinical recurrence rates were 17% at 1 yr, 38% at 3 yr, and 60% at 5 yr. Patients with colonic Crohn’s disease had a significantly shorter postoperative recurrence-free interval (median 1.2 yr) than patients with ileocecal (median 4.4 yr) or diffuse disease (median 3.0 yr) ( p = 0.01). On multivariable analysis, a high Pediatric Crohn’s Disease Activity Index at the time of surgery ( p = 0.01) and preoperative use of 6-mercaptopurine (6-MP) ( p < 0.005) were also independently associated with higher postoperative recurrence rates. There was a significant improvement in z scores for height ( p = 0.04) after surgery. CONCLUSIONS: In children undergoing resective surgery for Crohn’s disease, high rates of postoperative Crohn’s disease recurrence are associated with severe disease at the time of surgery, colonic Crohn’s disease, and the preoperative use of 6-MP. Patients who require preoperative use of 6-MP are likely to suffer from a more aggressive disease and would benefit from postoperative 6-MP prophylaxis. Height growth was improved after intestinal resection for Crohn’s disease.

Pediatric Crohn's disease: risk factors for postoperative recurrence.

Postoperative recurrence of Crohn's disease in adults has been extensively studied; however, the course of Crohn's disease after surgery in children has not been well defined. The aim of this study was to examine the postoperative course of pediatric Crohn's disease and the factors that may predict early postoperative recurrence. We identified 100 resective surgeries in 79 children with Crohn's disease seen at the Children's Hospital of Philadelphia between 1978 and 1996. A retrospective, multivariable analysis of factors potentially influencing postoperative clinical recurrence was performed. Preoperative and postoperative height measurements were compared, and z scores were computed for height-for-age. Two-tailed t test was used for the analysis. Clinical recurrence rates were 17% at 1 yr, 38% at 3 yr, and 60% at 5 yr. Patients with colonic Crohn's disease had a significantly shorter postoperative recurrence-free interval (median 1.2 yr) than patients with ileocecal (median 4.4 yr) or diffuse disease (median 3.0 yr) (p = 0.01). On multivariable analysis, a high Pediatric Crohn's Disease Activity Index at the time of surgery (p = 0.01) and preoperative use of 6-mercaptopurine (6-MP) (p < 0.005) were also independently associated with higher postoperative recurrence rates. There was a significant improvement in z scores for height (p = 0.04) after surgery. In children undergoing resective surgery for Crohn's disease, high rates of postoperative Crohn's disease recurrence are associated with severe disease at the time of surgery, colonic Crohn's disease, and the preoperative use of 6-MP. Patients who require preoperative use of 6-MP are likely to suffer from a more aggressive disease and would benefit from postoperative 6-MP prophylaxis. Height growth was improved after intestinal resection for Crohn's disease.

Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease.

Previous studies on risk factors for resection and postoperative recurrence in Crohn's disease have given inconclusive results. The aim of this study was to assess the risk for resection and postoperative recurrence in the treatment of ileocaecal Crohn's disease and to define factors affecting the course of the disease. A population-based cohort of 907 patients with primary ileocaecal Crohn's disease was reviewed retrospectively. Resection rates were 61, 77 and 83 per cent at 1, 5 and 10 years respectively after the diagnosis. Relapse rates were 28 and 36 per cent 5 and 10 years after the first resection. A younger age at diagnosis resulted in a low resection rate. The presence of perianal Crohn's disease and long resection segments increased the incidence of recurrence, and resection for a palpable mass and/or abscess decreased the recurrence rate. A decrease in recurrence rate during the study period (1955-1989) was observed. In ileocaecal Crohn's disease the probability of resection is high and the risk of recurrence moderate. Crohn's disease in childhood carries a lower risk of primary resection. Perianal disease and extensive ileal resection increase the risk of recurrence.

Prophylaxis of postoperative recurrence of Crohn's disease: Combination of antibiotic and probiotic versus mesalazine

Prophylaxis of postoperative recurrence of Crohn's disease: Combination of antibiotic and probiotic versus mesalazine

Lactobacillus GG in the prevention of postoperative recurrence of Crohn's disease: Preliminary results of a 12 months randomized, double-blind, placebo controlled clinical trial

Lactobacillus GG in the prevention of postoperative recurrence of Crohn's disease: Preliminary results of a 12 months randomized, double-blind, placebo controlled clinical trial

Prophylaxis of postoperative recurrence of Crohn's disease: Combination of antibiotic and probiotic versus mesalamine

Prophylaxis of postoperative recurrence of Crohn's disease: Combination of antibiotic and probiotic versus mesalamine

Safety and efficacy of granulocyte colony stimulating factor (G-CSF) for treatment of severe endoscopic postoperative recurrence in Crohn's disease (CD)

Safety and efficacy of granulocyte colony stimulating factor (G-CSF) for treatment of severe endoscopic postoperative recurrence in Crohn's disease (CD)

Risk factors for surgery and postoperative recurrence in Crohn's disease.

To assess the impact of possible risk factors on intestinal resection and postoperative recurrence in Crohn's disease (CD) and to evaluate the disease course. The results of previous studies on possible risk factors for surgery and recurrence in Crohn's disease have been inconsistent. Varying findings may be explained by referral biases and small numbers of patients in some studies. Data on initial intestinal resection and postoperative recurrence were evaluated retrospectively in a population-based cohort of 1,936 patients. The influence of concomitant risk factors was assessed using uni- and multivariate analyses. The cumulative rate of intestinal resection was 44%, 61%, and 71% at 1, 5, and 10 years after diagnosis. Postoperative recurrences occurred in 33% and 44% at 5 and 10 years after resection. The relative risk of surgery was increased in patients with CD involving any part of the small bowel, in those having perianal fistulas, and in those who were 45 to 59 years of age at diagnosis. Female gender and perianal fistulas, as well as small bowel and continuous ileocolonic disease, increase the relative risk of recurrence. Three of four patients with CD will undergo an intestinal resection; half of them will ultimately relapse. The extent of disease at diagnosis and the presence of perianal fistulas have an impact on the risk of surgery and the risk of postoperative recurrence. Women run a higher risk of postoperative recurrence than men. The frequency of surgery has decreased over time, but the postoperative relapse rate remains unchanged.

Prevention of postoperative recurrence in Crohn's disease.

Postoperative recurrence of Crohn's disease is often inevitable. Certain risk factors such as smoking, young age, and a perforating disease behavior have been identified. Patients with an enhanced risk profile should be treated with mesalamine or with azathioprine, the latter of which has higher success rates. An endoscopic evaluation of the neoterminal ileum performed 6 to 12 months after surgery provides important prognostic information regarding the further clinical course of the disease and can be used as a guide to optimize medical therapy.

Postoperative recurrence of Crohn's disease: pathophysiology and prevention.

Postoperative recurrence of Crohn's disease is often inevitable. Certain risk factors such as smoking, young age, and a perforating disease behavior have been identified. Patients running an enhanced risk should be treated with mesalamine or, with higher success rates, with azathioprine. An endoscopic evaluation of the neoterminal ileum 6 to 12 months after surgery provides relevant information predicting the further clinical course and can be used as a guide to adjust medical therapy.

The presence and severity of neural inflammation predict severe postoperative recurrence of Crohn's disease

The presence and severity of neural inflammation predict severe postoperative recurrence of Crohn's disease

POSTOPERATIVE RECURRENCE OF CROHN'S DISEASE IN CHILDREN

Background: Postoperative recurrence of Crohn's disease (CD) is well characterized in adults with symptomatic recurrence rates of 10% at 1 yr, 30% at 3 yrs and 40-50% at 5 yrs. To date, only one retrospective study has critically analyzed postoperative recurrence of CD in children. Methods: A retrospective analysis of patients with CD seen at CHOP from 1978-1996 who underwent resective surgery before 21 yrs of age was performed. Postoperative recurrence was defined as 1) CD-related symptoms with radiologic or endoscopic evidence of recurrence, or 2) an increase in Pediatric Crohn's Disease Activity Index (PCDAI) of >30 points with response to subsequent escalation in medical therapy. Recurrence rates were calculated using actuarial (Kaplan-Meier) log-rank analysis and correlated to specific historical, surgical and pathological factors. Results: Out of 339 pts with CD, 79 (23%) pts had resective surgeries. Records were available for 67 (85%) surgeries. 8 (12%) had colonic disease, 4 (6%) small bowel (SB) disease, 39 (58%) had ileocecal disease, and 16 (24%) had disease diffusely involving both the SB and colon. Average followup was 3.6 yr (med: 2.8 yr, range: 0-16.5 yr). Recurrence rate was 17% at 1yr, 38% at 3yrs, and 60% at 5 yrs. By univariate analysis, lymphopenia at surgery (p=0.05), or preoperative use of 6-mercaptopurine (6-MP) (p=0.004) or metronidazole (p=0.04) was associated with shorter recurrence free intervals (RFI) following surgery. Recurrence rate did not correlate with preoperative duration of CD or perforating indication for surgery. Patients with disease limited to the colon had a high rate of recurrence (Median RFI=1.16 yr), while those who had ileocecal disease had a low rate of recurrence (median RFI=4.36 yr), and those with diffuse disease (involving both the colon and SB) had an intermediate rate (median RFI=2.95 yr) (p=0.01). Multivariate analysis revealed that the use of 6-MP (p=0.0005) and a high PCDAI at the time of surgery (p=0.01) were independently associated with increased postoperative recurrence rates. Conclusions:Children with CD have a higher postoperative symptomatic recurrence rate than previously described in the adult literature. Children with colonic disease are at high risk for recurrence, those with diffuse disease are at intermediate risk, and those with ileocecal disease are at low risk for recurrence. Preoperative use of 6-MP and high PCDAI at surgery are independent predictors of early recurrence.