New research shows that more than 25% of patients with Crohn’s disease (CD) relapse after surgery, and those with ileal disease — inflammation and irritation of the ileum, the lower part of the small intestine — have more than a threefold higher risk of the disease recurring.
These results are from a review study titled “Systematic review with meta-analysis: recurrence of Crohn’s disease after total colectomy with permanent ileostomy,” published in the journal Alimentary Pharmacology and Therapeutics.
“Crohn’s disease patients who are having total colectomy and ileostomy have a low risk of recurrence,” Siddharth Singh, MD, of the division of gastroenterology at the University of California San Diego, said in a press release. “These patients should be monitored, and treatment started in case of recurrence. This is especially important for those patients who ever had Crohn’s disease involving the last part of the small intestine.”
Despite significant advances in the treatment of Crohn’s disease, almost half of patients require surgery within 10 years of their diagnosis, and about 30% require surgery at some point in their lifetime. But surgery rarely cures the disease, and most patients experience post-surgical disease recurrence.
To determine the rates, risk factors, and outcomes of recurrent Crohn’s disease after surgery, Singh and his colleagues searched for studies published through March 2016, eventually identifying 18 studies involving 1,438 adults with Crohn’s who underwent a total colectomy or proctocolectomy with permanent ileostomy. The studies had a median follow-up of 7.4 years.
They found that the overall risk for clinical recurrence after surgery was 28%, with a five-year and 10-year median cumulative rate of 23.5% and 40%, respectively.
The risk of surgical recurrence was 16.0 percent, with a five-year and 10-year median cumulative rate for recurrence of 10% and 18.5%, respectively.
The risk of clinical recurrence in patients without ileal disease at baseline was 11.5%, while the risk of surgical recurrence in these patients was 10.4%, the researchers found.
The results also showed that a history of ileal disease was associated with a 3.2-fold increased risk for disease recurrence.
Inconsistent risk factors for disease recurrence were penetrating disease and a young age at disease onset, researchers found.
The team concluded that continued medical therapy for patients with ileal disease is advisable given the higher risk of disease recurrence in these patients.
“In patients without ileal inflammation at surgery, continued endoscopic surveillance may identify asymptomatic disease recurrence to guide therapy,” the authors wrote in their review.