Post-operative Recurrence of Crohn’s Disease: There Is More to It than Meets the Eye
2016; Oxford University Press; Volume: 10; Issue: 9 Linguagem: Inglês
10.1093/ecco-jcc/jjw094
ISSN1876-4479
AutoresMarietta Iacucci, Subrata Ghosh, Marco Daperno,
Tópico(s)Helicobacter pylori-related gastroenterology studies
ResumoRecurrence after intestinal resection and anastomosis is a characteristic of Crohn’s disease [CD].1 Immunological and histological recurrence may be demonstrable within days after restoration of intestinal continuity.2 Endoscopic ulceration indicating recurrence occurs in a significant proportion of patients within a year of resection, but clinical recurrence and complications tend to follow endoscopic recurrence at variable intervals depending on the severity of endoscopic recurrence.3,4 Interventions to prevent recurrence have stratified patients either based on severity of endoscopic recurrence or based on putative phenotypic risk factors for recurrence soon after resection and anastomosis. To prevent either clinical recurrence or endoscopic recurrence, 5-aminosalicylic acid, antibiotics, thiopurines and tumour necrosis factor inhibitors [TNFi] have been used with variable single or composite endpoints and variable duration of follow-up. The results have been inconsistent and conflicting.5 In CD, and especially in the postoperative period, there is a marked disconnect between clinical symptoms and objective parameters of recurrent inflammation. This often poses problems in designing endpoints in interventional clinical trials.6,7 In an effort to establish a more objective surrogate endpoint, colonoscopy, wireless capsule video endoscopy, magnetic resonance enterography, trans-abdominal ultrasonography, and faecal calprotectin have all been used to detect early recurrence of CD after surgery. A formal scoring of the anastomotic recurrence at colonoscopy was developed to assist in the prediction of clinical recurrence and complications. This score, the Rutgeerts score, has stood … Corresponding author: Subrata Ghosh, MD, FRCP, FCAHS, Cumming School of Medicine, University of Calgary, North Tower – Room 930, 1403 – 29th Street NW Calgary, AB T2N 2T9, Canada. Tel: 1 403 944 8222; fax: 1 403 944 1095; email: Subrata.ghosh{at}albertahealthservices.ca
Referência(s)