title: Risk factors for repetitive ileocolic resection in patients with Crohn's disease: results of an observational cohort study.
abstract: BACKGROUND
  Surgical recurrence rates among patients with Crohn's disease with ileocolic resection (ICR) remain high, and factors predicting surgical recurrence remain controversial. We aimed to identify risk and protective factors for repetitive ICRs among patients with Crohn's disease in a large cohort of patients.
  
  
  METHODS
  Data on 305 patients after first ICR were retrieved from our cross-sectional and prospective database (median follow-up: 15 yr [0-52 yr]). Data were compared between patients with 1 (ICR = 1, n = 225) or more than 1 (ICR >1, n = 80) resection. Clinical phenotypes were classified according to the Montreal Classification. Gender, family history of inflammatory bowel disease, smoking status, type of surgery, immunomodulator, and biological therapy before, parallel to and after first ICR were analyzed.
  
  
  RESULTS
  The mean duration from diagnosis until first ICR did not differ significantly between the groups, being 5.93 ± 7.65 years in the ICR = 1 group and 5.36 ± 6.35 years in the ICR >1 group (P = 0.05). Mean time to second ICR was 6.7 ± 5.74 years. In the multivariate logistic regression analysis, ileal disease location (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.02-5.78; P = 0.05) was a significant risk factor. A therapy with immunomodulators at time of or within 1 year after first ICR (OR, 0.23; 95% CI, 0.09-0.63; P < 0.01) was a protective factor. Neither smoking (OR, 1.16; 95% CI, 0.66-2.06) nor gender (male OR, 0.85; 95% CI, 0.51-1.42) or family history (OR, 1.68; 95% CI, 0.84-3.36) had a significant impact on surgical recurrence.
  
  
  CONCLUSIONS
  Immunomodulators have a protective impact regarding surgical recurrence after ICR. In contrast, ileal disease location constitutes a significant risk factor for a second ICR.
authors.affiliation: *Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; †Gastroenterology Unit, Clinic of Internal Medicine, See-Spital, Horgen, Switzerland; ‡Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland; §Department of Gastroenterology and Hepatology, Triemlispital Zurich, Zurich, Switzerland; and ‖Division of Gastroenterology and Hepatology, University Hospital Lausanne/CHUV, Lausanne, Switzerland.
authors.forename: Christine N
authors.initials: CN
authors.lastname: Manser
authors.forename: Pascal
authors.initials: P
authors.lastname: Frei
authors.forename: Tanja
authors.initials: T
authors.lastname: Grandinetti
authors.forename: Luc
authors.initials: L
authors.lastname: Biedermann
authors.forename: Jessica
authors.initials: J
authors.lastname: Mwinyi
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.forename: Alain
authors.initials: A
authors.lastname: Schoepfer
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
mesh_terms: D000293:Adolescent; D000328:Adult; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000473:pathology* / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D010641:Phenotype; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult