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Anastomotic ulcers after ileocolic resection predict Crohn’s recurrence

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PHILADELPHIA — Anastomotic ulcers that develop after ileocolic resections are linked to the recurrence of Crohn’s disease and the need for future resection, according to research presented at the America College of Gastroenterology Annual Meeting.

“Recurrent inflammation is seen in approximately 70% of patients within one year,” Sarah Lopatin, MD, of the Mount Sinai Hospital, said in her presentation. “There is, however, some controversy as to the clinical implication of anastomotic ulcers and whether this represents a true disease recurrence or a post-surgical, ischemic or vascular phenomenon.”

Lopatin and colleagues sought to determine the prevalence of anastomotic ulcers, as well as any factors that might be associated with their development. They also wanted to assess the clinical impact of the ulcers defined as endoscopic recurrence of CD or the need for another ileocolic resection.

Investigators identified 184 patients who underwent resection at Mount Sinai Hospital between 2008 and 2017 who had a subsequent colonoscopy and Rutgeerts score. They collected disease and surgical characteristics, as well as postoperative colonoscopy findings for each patient.

They found that 97 patients had an anastomotic ulcer at the time of their first postoperative colonoscopy (52.7%). Further, the presence of an anastomotic ulcer at the time of the first colonoscopy was associated with their composite endpoint of CD recurrence and future resection (OR = 3.862; 95% CI, 1.29–11.59). Researchers did not find any risk factors associated with their development.

“Our results suggest that the presence of an anastomotic ulcer on first postoperative colonoscopy represents a risk factor for postoperative disease progression,” Lopatin said. “Prospective studies are needed to confirm these findings and look into the impact of medical therapies on anastomotic ulcers and disease progression.” – by Alex Young

Reference :

Lopatin S, et al. Abstract 14. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: The authors report no relevant financial disclosures.