Ambrogio Orlando1, Filippo Mocciaro2, Sara Renna3, Daniela Scimeca4, Antonio Rispo5, Maria Lia Scribano6, Anna Testa5, Annalisa Aratari7, Fabrizio Bossa4, Rosy Tambasco8, Erika Angelucci9, Sara Onali10, Maria Cappello11, Walter Fries12, Renata D'Incà13, Matteo Martinato13, Fabiana Castiglione5, Claudio Papi7, Vito Annese14, Paolo Gionchetti8, Fernando Rizzello8, Piero Vernia9, Livia Biancone10, Anna Kohn6, Mario Cottone3. 1. Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy. Electronic address: ambrogiorlando@gmail.com. 2. Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy. 3. Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy. 4. Department of Gastroenterology, IRCCS, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy. 5. Department of Gastroenterology, Federico II University, Naples, Italy. 6. Gastroenterology Unit, San Camillo Forlanini, Rome, Italy. 7. Department of Gastroenterology, San Filippo Neri Hospital, Rome, Italy. 8. Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy. 9. Department of Gastroenterology, Sapienza University, Rome, Italy. 10. Department of Gastroenterology, Tor Vergata University, Rome, Italy. 11. Department of Gastroenterology, Palermo University, Palermo, Italy. 12. Department of Gastroenterology, Messina University, Messina, Italy. 13. Department of Gastroenterology, Padua University, Padua, Italy. 14. Gastroenterology Unit II, AOU Careggi, Florence, Italy.
Abstract
INTRODUCTION: The incidence of endoscopic recurrence (ER) in Crohn's disease following curative resection is up to 75% at 1 year. Endoscopy is the most sensitive method to detect the earliest mucosal changes and the severe ER at 1 year seems to predict a clinical relapse. METHODS: The aim of this prospective study was to evaluate the incidence of early ER 6 months after curative resection. Secondary outcome was to evaluate the role of 5-aminosalicylic acid (5-ASA) in the prevention of ER at 6 months. A total of 170 patients were included in the study. They were carried-out from the evaluation of the appearance of ER during a trial performed to assess the role of azathioprine vs. 5-ASA as early treatment of severe ER. All the patients started 5-ASA treatment 2 weeks after surgery. RESULTS: Six months after surgery ER was observed in 105 patients (62%). The endoscopic score was reported as severe in 78.1% of them (82 out of 105). At univariable analysis only ileo-colonic disease influenced the final outcome associating to a lower risk of severe ER (p=0.04; OR 0.52, 95% CI 0.277-0.974). CONCLUSION: In this prospective Italian multicenter IG-IBD study a great proportion of ER occur within 6 months from ileo-colonic resection, with a significant rate of severe ER. Furthermore this study confirms the marginal role of 5-ASA in the prevention of ER. This suggests that post-surgical endoscopic evaluation should be performed at 6 months instead of 1 year to allow an adequate early treatment.
INTRODUCTION: The incidence of endoscopic recurrence (ER) in Crohn's disease following curative resection is up to 75% at 1 year. Endoscopy is the most sensitive method to detect the earliest mucosal changes and the severe ER at 1 year seems to predict a clinical relapse. METHODS: The aim of this prospective study was to evaluate the incidence of early ER 6 months after curative resection. Secondary outcome was to evaluate the role of 5-aminosalicylic acid (5-ASA) in the prevention of ER at 6 months. A total of 170 patients were included in the study. They were carried-out from the evaluation of the appearance of ER during a trial performed to assess the role of azathioprine vs. 5-ASA as early treatment of severe ER. All the patients started 5-ASA treatment 2 weeks after surgery. RESULTS: Six months after surgery ER was observed in 105 patients (62%). The endoscopic score was reported as severe in 78.1% of them (82 out of 105). At univariable analysis only ileo-colonic disease influenced the final outcome associating to a lower risk of severe ER (p=0.04; OR 0.52, 95% CI 0.277-0.974). CONCLUSION: In this prospective Italian multicenter IG-IBD study a great proportion of ER occur within 6 months from ileo-colonic resection, with a significant rate of severe ER. Furthermore this study confirms the marginal role of 5-ASA in the prevention of ER. This suggests that post-surgical endoscopic evaluation should be performed at 6 months instead of 1 year to allow an adequate early treatment.
Authors: Christopher Andrew Lamb; Nicholas A Kennedy; Tim Raine; Philip Anthony Hendy; Philip J Smith; Jimmy K Limdi; Bu'Hussain Hayee; Miranda C E Lomer; Gareth C Parkes; Christian Selinger; Kevin J Barrett; R Justin Davies; Cathy Bennett; Stuart Gittens; Malcolm G Dunlop; Omar Faiz; Aileen Fraser; Vikki Garrick; Paul D Johnston; Miles Parkes; Jeremy Sanderson; Helen Terry; Daniel R Gaya; Tariq H Iqbal; Stuart A Taylor; Melissa Smith; Matthew Brookes; Richard Hansen; A Barney Hawthorne Journal: Gut Date: 2019-09-27 Impact factor: 23.059
Authors: María Jesús Martínez; Tomás Ripollés; Jose María Paredes; Eduardo Moreno-Osset; Juan Manuel Pazos; Esther Blanc Journal: Dig Dis Sci Date: 2019-01-02 Impact factor: 3.199
Authors: Zipporah Iheozor-Ejiofor; Morris Gordon; Andrew Clegg; Suzanne C Freeman; Teuta Gjuladin-Hellon; John K MacDonald; Anthony K Akobeng Journal: Cochrane Database Syst Rev Date: 2019-09-12
Authors: S Mondot; P Lepage; P Seksik; M Allez; X Tréton; Y Bouhnik; J F Colombel; M Leclerc; P Pochart; J Doré; P Marteau Journal: Gut Date: 2015-12-01 Impact factor: 23.059