Rate and risk factors of postoperative endoscopic recurrence of moderate- to high-risk Crohn's disease patients - A real-world experience from a Middle Eastern cohort
Nahla Azzam1, Yazed AlRuthia2, Abdulla Al Thaher1, Majid Almadi3, Othman Alharbi1, Mansour Altuwaijri1, Suliman Alshankiti1, Mohammed Alanazi1, Abdulelah Alanazi1, Abdulrahman Aljebreen1, Miguel Regueiro4
1 Department of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
2 Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
3 Department of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia; Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, Montreal, QC, Canada
4 Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, United State of America
Dr. Nahla Azzam
Division of Gastroenterology, Department of Medicine, King Saud University, Po Box 2925, 12372, Riyadh
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Crohn's disease (CD) frequently recurs after intestinal resection. Azathioprine (AZA) and biological therapies have shown efficacy in preventing postoperative recurrence (POR). Data on POR from Middle Eastern populations is lacking. This study aimed to evaluate the rate of endoscopic POR in a cohort of CD patients who underwent ileocecal resection (ICR), and to assess the effectiveness of AZA and biological therapies in reducing the risk of disease recurrence.
Methods: We performed a retrospective cohort study on 105 CD patients followed at our center, who underwent ileal resection and were at moderate to high risk for POR. Clinical and laboratory data were collected; the primary endpoint was post ICR endoscopic recurrence at 24 months defined by Rutgeerts' score of i2 or more despite treatment.
Results: In total, 105 patients with Crohn's disease met our inclusion criteria; 76.2% were in remission and did not have endoscopic POR at 24 months. Further, 41.9% were on biological therapy, and 34.3% were mainly on AZA. Out of the 28.2% who had POR, approximately 15% were on biological therapies. Penetrating phenotype was the only predictive factor for decreasing POR (OR = 0.19, 95% CI: 0.04–0.98, P = 0.04) as identified in multiple logistic regression analysis.
Conclusions: The use of biological therapies post-surgery was not superior than AZA in reducing the endoscopic POR for mod- high risk CD patients. Only penetrating behavior of the CD was associated with significantly lower risk of endoscopic recurrence. This finding is worth further investigation in more robust study designs and among larger samples of patients.