title: Does the initial location of Crohn's disease have an influence on the time-to-relapse in patients under maintenance treatment with oral mesalamine?
abstract: The aim of this study was to determine the possible influence of the initial location of Crohn's disease (CD) on the time-to-relapse in patients with quiescent CD treated only with oral mesalamine (5-ASA). We divided 74 consecutive patients in clinical remission into three groups according to the initial location of CD. Group A consisted of 30 cases with an ileal location; group B, 18 with ileocolonic location; and group C, 26 with a colonic location. The patients entered the study if they were in clinical and endoscopic remission for at least 3 months. Relapse was defined by CD Activity Index > or = 150, CD Endoscopic Index of Severity > or =4, and by an abnormal increase of C-reactive protein, white blood cell count, and erythrocyte sedimentation rate; moreover, if it was confirmed by x-ray and/or endoscopy. Time-to-relapse was defined as the interval between the date of enrollment and the date of relapse. The patients with an ileal location showed a relapse within 5 years, with a time-to-relapse of 1 year in 26% of cases, 2 years in 85%, 3 years in 92%, and 4 years in 96%. The patients with ileocolonic location showed a relapse within 4 years, with time-to-relapse of 1 year in 39% of cases, 2 years in 89%, and 3 years in 94%. The cases with a colonic location showed a relapse within 6 years, with time-to-relapse of 1 year in 33% of cases, 2 years in 71%, 3 years in 79%, and 4 years in 87%. Surgical treatment was necessary in 37% of the cases with an ileal location, in 44% with ileocolonic location, and 17% with a colonic location. In conclusion, even if our data lack a statistical significance, we have found that the initial anatomic involvement is not a valid parameter to predict the relapse risk in a homogeneous group under continuous treatment with oral 5-ASA, although ileocolonic location seems to have a more aggressive course.
authors.affiliation: Department of Gastroenterology, Azienda Ospedaliera Pisana, Italy. bresci@plus.it
authors.forename: G
authors.initials: G
authors.lastname: Bresci
authors.forename: G
authors.initials: G
authors.lastname: Parisi
authors.forename: M
authors.initials: M
authors.lastname: Bertoni
authors.forename: P
authors.initials: P
authors.lastname: Masolino
authors.forename: F
authors.initials: F
authors.lastname: Scatena
authors.forename: A
authors.initials: A
authors.lastname: Capria
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D003092:Colitis / Q000175:diagnosis / Q000188:drug therapy; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007079:Ileitis / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D011379:Prognosis; D012008:Recurrence; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine