Recurrence patterns after first resection for stricturing or penetrating Crohn's disease.
BACKGROUND
Crohn's disease (CD) usually recurs after resection, but the factors associated with this risk remain obscure. We set out to determine the role of stricturing (Montreal Classification B2) versus penetrating (Classification B3) disease behavior in predicting early (<3 years) versus late (>or=3 years) postoperative recurrence.


METHODS
We identified a cohort of 34 patients seen at The Mount Sinai Hospital who had undergone a first ileocolic resection prior to December 31, 2004, who had been clinically thought to have had stricturing (B2) disease, and for whom we could verify 1) the operative and surgical pathology findings; and 2) the time of onset of symptoms attributable to recurrent CD by endoscopy, radiology, or surgery. Cases were reclassified as either "stricturing" (B2) or "penetrating" (B3) on the basis of operative and surgical pathology reports. Recurrences were classified as either "early" (<3 years) or "late" (>or=3 years) depending on the first appearance of postoperative symptoms that were verified endoscopically and histologically, radiologically, or surgically as being attributable to anastomotic recurrence of the CD.


RESULTS
Among these 34 patients clinically thought to have had B2 disease, 12 had B2 disease confirmed upon review of surgical and pathology reports and none of them had recurrence within 3 years. Among the 22 patients reclassified as B3 disease, 12 (55%) had early recurrence. This difference was significant at the 0.002 level by the Fisher Exact Test.


CONCLUSIONS
There is a strong proclivity for early postoperative recurrence of penetrating CD compared to stricturing disease, which may not be evident by behavioral classification on clinical grounds alone. Patients with confirmed uncomplicated stricturing obstruction at their first resection seem unlikely to experience a clinical recurrence within the next 3 years.
Sachar
David B
DB
Department of Medicine, Division of Gastroenterology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. david.sachar@mountsinai.org
Lemmer
Eric
E
Ibrahim
Christopher
C
Edden
Yair
Y
Ullman
Thomas
T
Ciardulo
Julie
J
Roth
Esther
E
Greenstein
Adrian J
AJ
Bauer
Joel J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000145:classification / Q000453:epidemiology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007079:Ileitis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D007412:Intestinal Fistula / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult