Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease.
OBJECTIVE
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.
McLeod
R S
RS
Department of Surgery, University of Toronto, Ontario, Canada.
Wolff
B G
BG
Steinhart
A H
AH
Carryer
P W
PW
O'Rourke
K
K
Andrews
D F
DF
Blair
J E
JE
Cangemi
J R
JR
Cohen
Z
Z
Cullen
J B
JB
Chaytor
R G
RG
Greenberg
G R
GR
Jaffer
N M
NM
Jeejeebhoy
K N
KN
MacCarty
R L
RL
Ready
R L
RL
Weiland
L H
LH
D000206:Actuarial Analysis; D000328:Adult; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome