Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 113; no. 6; pp. 1823 - 1827
• Main Authors: McLeod, RS, Wolff, BG, Steinhart, AH, Carryer, PW, O'Rourke, K, Andrews, DF, Blair, JE, Cangemi, JR, Cohen, Z, Cullen, JB, Chaytor, RG, Greenberg, GR, Jaffer, NM, Jeejeebhoy, KN, MacCarty, RL, Ready, RL, Weiland, LH
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-12-1997; Elsevier
• Subjects: Actuarial Analysis; Adult; Biological and medical sciences; Crohn Disease - diagnostic imaging; Crohn Disease - pathology; Crohn Disease - surgery; Digestive system. Abdomen; Endoscopy; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Radiography; Recurrence; Risk Factors; Treatment Outcome; Human; Postoperative; Evaluation; Recurrence; Radiodiagnosis; Instrumentation therapy; Inflammatory disease; Non steroidal antiinflammatory agent; Crohn disease; Randomization; Analgesic; Mesalazine; Placebo; Antipyretic; Radiology; Digestive diseases; Intestinal disease; Endoscopy; Salicylates; Comparative study
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1016/S0016-5085(97)70001-5

BACKGROUND & AIMS: The aim of this study was to determine the risk of endoscopic/radiological recurrence of Crohn's disease postoperatively and the long-term outcome.
METHODS: A randomized placebo-controlled trial was performed to determine the effectiveness of mesalamine in preventing recurrent Crohn's disease postoperatively. Patients in the control group were examined endoscopically/radiologically before entry into and annually during the trial. Findings were classified as minimal or severe.
RESULTS: There were 76 patients (49 men and 37 women; mean age, 37.1 +/- 13.2 years). Fifty (61.7%) had terminal ileal resections. Overall, 55 endoscopic/radiological recurrences were observed in 51 patients (67.1%). Expressed actuarially, the recurrence rate was 27.5% at 1 year (95% confidence interval [CI], 15.8%-37.6%), 60.8% at 2 years (95% CI, 46%-71.3%), and 77.3% at 3 years (95% CI, 62.7%-86.3%). Nineteen (37%) were symptomatic and 12 (24%) were initially asymptomatic but later became symptomatic (mean, 13.0 +/- 8.8 months), whereas 20 (39%) remained asymptomatic (mean, 16.9 +/- 17.4 months). Patients with severe endoscopic/radiological disease were significantly more likely to be or become symptomatic than those with minimal disease (23 of 32 vs. 8 of 19, respectively; P = 0.0437).
CONCLUSIONS: This study suggests that postoperative endoscopic/radiological recurrences occur later than previously reported. Furthermore, many of these patients, especially with minimal disease, will remain asymptomatic. (Gastroenterology 1997 Dec;113(6):1823-7)