title: Early post-operative endoscopic recurrence in Crohn's disease patients: data from an Italian Group for the study of inflammatory bowel disease (IG-IBD) study on a large prospective multicenter cohort.
abstract: BACKGROUND
  The incidence of endoscopic recurrence (ER) in Crohn's disease following curative resection is up to 75% at 1 year. Endoscopy is the most sensitive method to detect the earliest mucosal changes and the severe ER at 1 year seems to predict a clinical relapse.
  
  
  METHODS
  The aim of this prospective study was to evaluate the incidence of early ER 6 months after curative resection. Secondary outcome was to evaluate the role of 5-aminosalicylic acid (5-ASA) in the prevention of ER at 6 months. A total of 170 patients were included in the study. They were carried-out from the evaluation of the appearance of ER during a trial performed to assess the role of azathioprine vs. 5-ASA as early treatment of severe ER. All the patients started 5-ASA treatment 2 weeks after surgery.
  
  
  RESULTS
  Six months after surgery ER was observed in 105 patients (62%). The endoscopic score was reported as severe in 78.1% of them (82 out of 105). At univariable analysis only ileo-colonic disease influenced the final outcome associating to a lower risk of severe ER (p=0.04; OR 0.52, 95% CI 0.277-0.974).
  
  
  CONCLUSIONS
  In this prospective Italian multicenter IG-IBD study a great proportion of ER occur within 6 months from ileo-colonic resection, with a significant rate of severe ER. Furthermore this study confirms the marginal role of 5-ASA in the prevention of ER. This suggests that post-surgical endoscopic evaluation should be performed at 6 months instead of 1 year to allow an adequate early treatment.
authors.affiliation: Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy. Electronic address: ambrogiorlando@gmail.com.
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Orlando
authors.affiliation: Gastroenterology and Endoscopy Unit, ARNAS Civico Hospital, Palermo, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Mocciaro
authors.affiliation: Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Renna
authors.affiliation: Department of Gastroenterology, IRCCS, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Scimeca
authors.affiliation: Department of Gastroenterology, Federico II University, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rispo
authors.affiliation: Gastroenterology Unit, San Camillo Forlanini, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Lia Scribano
authors.affiliation: Department of Gastroenterology, Federico II University, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Testa
authors.affiliation: Department of Gastroenterology, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Aratari
authors.affiliation: Department of Gastroenterology, IRCCS, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Bossa
authors.affiliation: Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Rosy
authors.initials: R
authors.lastname: Tambasco
authors.affiliation: Department of Gastroenterology, Sapienza University, Rome, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Angelucci
authors.affiliation: Department of Gastroenterology, Tor Vergata University, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Onali
authors.affiliation: Department of Gastroenterology, Palermo University, Palermo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Cappello
authors.affiliation: Department of Gastroenterology, Messina University, Messina, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Fries
authors.affiliation: Department of Gastroenterology, Padua University, Padua, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: D'Incà
authors.affiliation: Department of Gastroenterology, Padua University, Padua, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Martinato
authors.affiliation: Department of Gastroenterology, Federico II University, Naples, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Castiglione
authors.affiliation: Department of Gastroenterology, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Papi
authors.affiliation: Gastroenterology Unit II, AOU Careggi, Florence, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
authors.affiliation: Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gionchetti
authors.affiliation: Department of Internal Medicine, Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rizzello
authors.affiliation: Department of Gastroenterology, Sapienza University, Rome, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Vernia
authors.affiliation: Department of Gastroenterology, Tor Vergata University, Rome, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Biancone
authors.affiliation: Gastroenterology Unit, San Camillo Forlanini, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Kohn
authors.affiliation: Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cottone
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003113:Colonoscopy; D003424:Crohn Disease / Q000473:pathology* / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine
keywords: 5-Aminosalicylic acid; Crohn's disease; Endoscopic recurrence; Severe recurrence