New Meta-Analysis Examines Rate of Recurrence in Patients with Crohn’s Disease

A new study found that about one-third of patients who underwent surgical treatment for Crohn disease experience a clinical recurrence, and 16% develop a surgical recurrence. In addition, researchers found that patients where the terminal ileum was affected by Crohn disease were 3.2-times more lilely to have recurrence than those without.

The new review, led by Dr Siddhartha Singh at the Division of Gastroenterology with the University of California, San Diego, Department of Medicine, examines the risk factors, rates, and outcomes of recurrence for patients who underwent surgery to better understand the natural history of Crohn disease after surgery. Researchers collected cohort studies, case series, and randomized control trails of patients with Crohn disease who underwent the removal of the large intestine (total colectomy) with the permanent opening of the abdominal wall (permanent ileostomy) and reported recurrence of Crohn disease, both clinical or surgical, within 1 year. 
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The 18 studies included in the analysis included 1438 adults, who had a median follow-up of 7.4 years. The risk of recurrence was 28%. There was a 5-year median cumulative rate of 23.5% and a 10-year median cumulative rate of 40.0%. A history of ileal disease was a common risk factor for the recurrence of Crohn disease.

The findings illustrate a need to further investigate the recurrence of Crohn after surgery and for clinicians to monitor patients who underwent surgery, particularly if the patient has a history of ileal disease, as it increases his or her risk of recurrence.

“Patients with known subclinical ileal disease, presence of disease-related complications (like penetrating and/or perianal disease), failure of biological therapy prior to TC-PI, may be at high risk of recurrence of [Crohn disease] after TC-PI, and may be considered for continued pharmacological prophylaxis and/or periodic endoscopic monitoring of end ileostomy,” the researchers concluded.

—Melissa Weiss

Reference:

Fumery M, Dulai PS, Farrell AM, et al. Systematic review with meta-analysis: recurrence of Crohn’s disease after total colectomy with permanent ileostomy [published online December 8, 2016]. Aliment Pharmacol Therap. doi: doi:10.1111/apt.13886