title: Early diagnosis and treatment of postoperative endoscopic recurrence of Crohn's disease: partial benefit by infliximab--a pilot study.
abstract: BACKGROUND
  Current data indicate that infliximab-given immediately after surgery-may be very effective in preventing postsurgical recurrence of Crohn's disease. However, it is unknown whether a similar benefit would result from early diagnosis and treatment, rather than prevention of endoscopic recurrence.
  
  
  OBJECTIVE
  The primary outcome of this study was to clarify whether infliximab, given after diagnosis of postoperative endoscopic recurrence of Crohn's diseases (Rutgeerts score ≥ 2) can induce endoscopic remission (score <2) at 54 weeks. The secondary outcomes were improvement in the endoscopic score and clinical recurrence at 54 weeks.
  
  
  METHODS
  In this prospective open label multicenter pilot study 43 patients with ileocolonic Crohn's disease subjected to curative surgery underwent colonoscopy 6 months after surgery. Patients with endoscopic recurrence (Rutgeerts score ≥2) were treated with either mesalamine 800 mg tid or infliximab 5 mg/kg bw on a maintenance basis. Colonoscopy was performed after 54 weeks of therapy.
  
  
  RESULTS
  A total of 24/43 patients were diagnosed with endoscopic recurrence at 6 months. Thirteen were treated with infliximab and 11 with mesalamine. None of the 11 mesalamine-treated patients had endoscopic remission at 54 weeks. Two had clinical recurrence at 8 and 9 months. Fifty-four percent of patients treated with infliximab had endoscopic remission at 54 weeks (P = 0.01) while 69% had an improvement in the endoscopic score. None had clinical recurrence.
  
  
  CONCLUSIONS
  Treatment of postsurgical endoscopic lesions by infliximab appears superior to mesalamine. However, a sizeable proportion of patients did not fully benefit from this strategy.
authors.affiliation: Department of Clinical and Experimental Pathology, University of Udine School of Medicine, Udine, Italy. Sorrentino@uniud.it
authors.forename: Dario
authors.initials: D
authors.lastname: Sorrentino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Terrosu
authors.forename: Alberto
authors.initials: A
authors.lastname: Paviotti
authors.forename: Marco
authors.initials: M
authors.lastname: Geraci
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zoli
authors.forename: Walter
authors.initials: W
authors.lastname: Fries
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
authors.forename: Pietro
authors.initials: P
authors.lastname: Occhipinti
authors.forename: Tiziano
authors.initials: T
authors.lastname: Croatto
authors.forename: Dimitra
authors.initials: D
authors.lastname: Zarifi
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D003424:Crohn Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011184:Postoperative Period; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D019804:Mesalamine; D000069285:Infliximab