title: Impact of azathioprine on the prevention of postoperative Crohn's disease recurrence: results of a prospective, observational, long-term follow-up study.
abstract: BACKGROUND
  Postoperative recurrence (PR) occurs early after intestinal resection in >75% of Crohn's disease (CD) patients. No well-established strategy for long-term PR prevention is available. The aim was to prospectively evaluate the long-term endoscopic and clinical outcomes of postoperative CD on maintenance treatment with azathioprine (AZA), especially in patients who developed endoscopic lesions confined to the ileocolic anastomosis.
  
  
  METHODS
  Long-term AZA therapy (2-2.5 mg/kg/day) was initiated immediately after surgery in 56 consecutive patients who underwent a curative intestinal resection. Clinical and biological assessments every 3 months, as well as yearly endoscopic evaluation, were performed until the end of the study or clinical PR (CPR).
  
  
  RESULTS
  Thirty-seven patients (70%) showed mucosal lesions at endoscopy after a median of 12 months (range 12-60); however, in 15 of these patients lesions were confined to the anastomosis and only 6 showed endoscopic progression, but none of them developed CPR. Among the remaining 22 patients with endoscopic PR (EPR), 23% suffered a CPR during follow-up. Thirty percent of patients remained free of EPR after a median follow-up of 33 months (range 12-84). The cumulative probability of EPR was 44%, 53%, 69%, and 82%, at 1, 2, 3, and 5 years, respectively. No predictive factors of EPR were found.
  
  
  CONCLUSIONS
  Early postoperative use of AZA seems to delay EPR development in comparison to historical series or placebo groups in randomized controlled trials. Although usually considered as endoscopic recurrence, those lesions confined to the ileocolonic anastomosis are not likely to progress or to become symptomatic in the short term.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain. edomenech.germanstrias@gencat.net
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
authors.forename: Míriam
authors.initials: M
authors.lastname: Mañosa
authors.forename: Isabel
authors.initials: I
authors.lastname: Bernal
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.forename: Eduard
authors.initials: E
authors.lastname: Cabré
authors.forename: Marta
authors.initials: M
authors.lastname: Piñol
authors.forename: Vicente
authors.initials: V
authors.lastname: Lorenzo-Zúñiga
authors.forename: Jaume
authors.initials: J
authors.lastname: Boix
authors.forename: Miquel A
authors.initials: MA
authors.lastname: Gassull
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use*; D002648:Child; D003082:Colectomy; D003113:Colonoscopy; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine