Non-invasive diagnosis and grading of postsurgical endoscopic recurrence in Crohn's disease

Abstract Background Prevention of postoperative recurrence is a critical goal in Crohn’s disease (CD) management. Currently, postsurgical CD management and treatment are based on endoscopic monitoring performed within the first year after surgery. However, colonoscopy (CS) is an invasive and expensive procedure, unpleasant to patients. A non-invasive and patient friendly approach is required. Methods Consecutive CD patients who underwent ileo-cecal resection from July 2017 to January 2020 were prospectively enrolled in three Italian Centers and performed CS and bowel ultrasound (US) after six months from the surgery, in a blinded fashion. The patients also underwent complete clinical assessment and blood and stool samples were obtained for C-reactive protein (CRP), and fecal calprotectin (FC) measurements. The disease was considered clinically active if the Harvey–Bradshaw Index (HBI) was higher than 4. Uni- and multivariable analyses were used to assess the correlation between non-invasive parameters, including bowel US findings and FC values and endoscopic recurrence, defined by a Rutgeerts’s score (RS) > 2. Sensitivity, specificity, accuracy, PPV and NPV of bowel US parameters alone and in combination with FC in assessing endoscopic recurrence were calculated. Results Seventy patients were enrolled, 45 patients (64%) had an endoscopic recurrence (RS > 2) at 6 months. Thirteen out of 45 (29%) were symptomatic (HBI > 4). Bowel wall thickness (BWT), bowel wall flow (BWF, presence of vascular signals at color Doppler), the presence of mesenteric hypertrophy, the presence of limph-nodes and FC values significantly correlated with the endoscopic recurrence (p < 0.005). Independent predictors for endoscopic recurrence were BWT (for 1-mm increase: OR 2.63; 95% CI 1.136.12; p= 0.024), presence of lymph-nodes (OR 23.24; 95% CI 1.85291.15; p= 0.014) and FC > 50 µg/g (OR 11.86; 95% CI 2.60–54.09; p= 0.001). Sensitivity, specificity, accuracy, PPV and NPV of bowel US and/or FC are showed in Table 1. Table 1: Diagnostic accuracy of Bowel US and/or FC compared to CS in assessing endoscopic activity (CI 95%): per-patient analysis Conclusion Combined use of bowel US and FC is accurate in assessing endoscopic recurrence at 6 months in CD patients and represent a valid alternative to endoscopic assessment after surgery

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IDDF2020-ABS-0204 Fecal microbiota as a non-invasive identification for postoperative endoscopic recurrence in Crohn’s disease patients

10.1136/gutjnl-2020-iddf.10 ◽

2020 ◽

Author(s):

Haichao Wang ◽

Guorong Yan ◽

Yaling Wu ◽

Chen Ye ◽

Deji Zhuoma ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Fecal Microbiota ◽

Non Invasive ◽

Endoscopic Recurrence

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A non-invasive comparison between NASH and Crohn's disease

Zeitschrift für Gastroenterologie ◽

10.1055/s-0036-1597384 ◽

2016 ◽

Vol 54 (12) ◽

pp. 1343-1404

Author(s):

K Willuweit ◽

M Brandenburg ◽

S Sydor ◽

S Aßmuth ◽

A Wegehaupt ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Non Invasive

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S1214 Early Post-Operative Endoscopic Recurrence in Crohn's Disease in an Italian Multicentric Cohort

Gastroenterology ◽

10.1016/s0016-5085(10)60930-4 ◽

2010 ◽

Vol 138 (5) ◽

pp. S-205

Author(s):

Ambrogio Orlando ◽

Daniela Scimeca ◽

Filippo Mocciaro ◽

Anna Testa ◽

Annalisa Aratari ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Endoscopic Recurrence

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Anastomotic Ulcers After Ileocolic Resection for Crohn’s Disease Are Common and Predict Recurrence

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz224 ◽

2019 ◽

Vol 26 (7) ◽

pp. 1050-1058 ◽

Cited By ~ 3

Author(s):

Robert P Hirten ◽

Ryan C Ungaro ◽

Daniel Castaneda ◽

Sarah Lopatin ◽

Bruce E Sands ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Multivariable Analysis ◽

Disease Recurrence ◽

Ileocolic Resection ◽

Anastomotic Ulcer ◽

Endoscopic Recurrence ◽

Academic Center ◽

Endoscopic Remission ◽

The Impact

Abstract Background Crohn’s disease recurrence after ileocolic resection is common and graded with the Rutgeerts score. There is controversy whether anastomotic ulcers represent disease recurrence and should be included in the grading system. The aim of this study was to determine the impact of anastomotic ulcers on Crohn’s disease recurrence in patients with prior ileocolic resections. Secondary aims included defining the prevalence of anastomotic ulcers, risk factors for development, and their natural history. Methods We conducted a retrospective cohort study of patients undergoing an ileocolic resection between 2008 and 2017 at a large academic center, with a postoperative colonoscopy assessing the neoterminal ileum and ileocolic anastomosis. The primary outcome was disease recurrence defined as endoscopic recurrence (>5 ulcers in the neoterminal ileum) or need for another ileocolic resection among patients with or without an anastomotic ulcer in endoscopic remission. Results One hundred eighty-two subjects with Crohn’s disease and an ileocolic resection were included. Anastomotic ulcers were present in 95 (52.2%) subjects. No factors were associated with anastomotic ulcer development. One hundred eleven patients were in endoscopic remission on the first postoperative colonoscopy. On multivariable analysis, anastomotic ulcers were associated with disease recurrence (adjusted hazard ratio [aHR] 3.64; 95% CI, 1.21–10.95; P = 0.02). Sixty-six subjects with anastomotic ulcers underwent a second colonoscopy, with 31 patients (79.5%) having persistent ulcers independent of medication escalation. Conclusion Anastomotic ulcers occur in over half of Crohn’s disease patients after ileocolic resection. No factors are associated with their development. They are associated with Crohn’s disease recurrence and are persistent.

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The Correlation between Vitamin D Levels and the Risk of Postoperative Recurrence in Crohn’s Disease

Digestion ◽

10.1159/000513589 ◽

2021 ◽

pp. 1-9

Author(s):

Akihiro Yamada ◽

Yuga Komaki ◽

Fukiko Komaki ◽

Haider Haider ◽

Dejan Micic ◽

...

Keyword(s):

Vitamin D ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Postoperative Recurrence ◽

Recurrence Rates ◽

Reactive Protein ◽

Endoscopic Recurrence ◽

Vitamin D Levels ◽

Endoscopic Remission ◽

The University

Background and Aims: Vitamin D deficiency has been associated with disease activity in Crohn’s disease (CD). We assessed whether there is a correlation between vitamin D levels and the risk of postoperative recurrence in CD. Methods: CD patients who underwent surgery were identified from a prospectively maintained database at the University of Chicago. The primary endpoint was the correlation of serum 25-hydroxy vitamin D levels measured at 6–12 months after surgery and the proportion of patients in endoscopic remission, defined as a simple endoscopic score for CD of 0. Clinical, biological (C-reactive protein), and histologic recurrences were also studied. Results: Among a total of 89 patients, 17, 46, and 26 patients had vitamin D levels of <15, 15–30, and >30 ng/mL, respectively. Patients with higher vitamin D levels were significantly more likely to be in endoscopic remission compared to those with lower levels (23, 42, and 67% in ascending tertile order; p = 0.028). On multivariate analysis, vitamin D >30 ng/mL (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.07–0.66, p = 0.006) and anti-tumor necrosis factor agent treatment (OR 0.25, 95% CI 0.08–0.83, p = 0.01) were associated with reduced risk of endoscopic recurrence. Rates of clinical, biological, and histologic remission trended to be higher in patients with higher vitamin D levels (p = 0.17, 0.55, 0.062, respectively). Conclusion: In the present study, higher vitamin D level was associated with lower risk of postoperative endoscopic CD recurrence. Further, studies are warranted to assess the role of vitamin D in postoperative CD recurrence.

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P229 The modified postoperative endoscopic recurrence score for Crohn's disease: Does it really make a difference in predicting clinical recurrence?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.354 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S194-S194

Author(s):

P. Rivière ◽

S. Vermeire ◽

G. Van Assche ◽

P. Rutgeerts ◽

A. De Buck van Overstraeten ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Recurrence Score ◽

Clinical Recurrence ◽

Endoscopic Recurrence

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Strategies for Preventing Endoscopic Recurrence of Crohn’s Disease 1 Year after Surgery: A Network Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2017/7896160 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Jin-shan Feng ◽

Jin-yu Li ◽

Xiu-yan Chen ◽

Zheng Yang ◽

Shang-hai Li

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Meta Analysis ◽

Credible Interval ◽

Ileal Resection ◽

Randomized Controlled ◽

Endoscopic Recurrence ◽

Central Database ◽

Lactobacillus Gg

Objective. To assess the benefits of different treatments that aim to prevent the endoscopic recurrence of Crohn’s disease (CD) after ileal resection. Methods. Randomized controlled trials (RCTs) were searched from MEDLINE, Embase, and the Cochrane Central Database. All the included RCTs with an endoscopic recurrence outcome which was defined as Rutgeerts’ score ≥ i2 have a duration of more than 1 year. The quality of the included RCTs was assessed by the Cochrane Risk of Bias Tool. Pairwise treatment effects were estimated through a Bayesian random effects network meta-analysis by using the OpenBUGS 1.4 software and reported as odds ratios (ORs) with a 95% credible interval (CI). Results. Fourteen RCTs (877 participants) were included. Two strategies were superior to placebo for preventing endoscopic recurrence of CD at 1 year after surgery: infliximab (d, −5.475; 95% CI, −10.47 to –1.632) and adalimumab (d, −7.273; 95% CI, −13.84 to −2.585). Nine strategies were not effective: budesnoid, mesalazine (in both high and low dose), azathioprine, Tripterygium wilfordii, mesalazine + infliximab, ornidazole, untreated intervention, and Lactobacillus GG. Conclusions. Except for infliximab and adalimumab, other strategies included in our analysis were not effective for preventing endoscopic recurrence of CD at 1 year after ileal resection.

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