Histologic activity not linked to recurrence in postoperative Crohn’s disease
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Histologic activity was not associated with recurrence in patients who were in complete endoscopic remission after ileocolonic resection for Crohn’s disease, according to new data.
“Prior studies suggest endoscopic recurrence, the goal treat-to-target endpoint, precedes both clinical and surgical recurrence in postoperative Crohn’s disease after ileocolonic resection. Although it is thought that histologic recurrence precedes endoscopic recurrence, it is unclear if it is associated with endoscopic recurrence and can be utilized as a potential treat-to-target endpoint for postoperative Crohn’s disease,” Ravi S. Shah, MD, from the Digestive Disease Institute at Cleveland Clinic, said during a virtual poster presentation at the ACG Annual Scientific Meeting. “The primary aim [of our study] is to determine the impact of histologic activity on postoperative progression or recurrence in Crohn’s disease patients in endoscopic remission following ileocolonic resection.”
For their study, Shah and colleagues identified adults with CD who underwent ileocolonic resection between 2009 and 2020 with histologically active vs. quiescent activity on endoscopic biopsy in those with an endoscopic Rutgeerts score of i0. The primary outcome was composite recurrence, which was defined as endoscopic, radiologic, surgical or pharmacologic recurrence.
Of the 79 patients evaluated (mean age, 34 years), 48 had histologically quiescent and 31 had histologically active disease. Patients primarily had ileocolonic or small-bowel disease with a stricturing phenotype and, importantly, approximately 40% received prophylactic biologic therapy, Shah noted. However, there were no significant differences in patient or disease characteristics or the use of preoperative or prophylactic biologic use between groups.
Postoperative recurrence occurred in 54.2% of patients with histologically quiescent disease, as compared with 64.5% of those with histologically active disease. However, there were no significant differences in the composite, endoscopic, radiologic, surgical or pharmacologic recurrence rates, according to Shah.
In a Cox proportional hazard model, histologic activity was associated with increased postoperative recurrence rates, but this finding did not reach statistical significance. Results also showed that active smoking significantly increased postoperative recurrence, and prophylactic biologic therapy significantly decreased recurrence.
“In this single-center, retrospective study, histologic activity in patients in complete endoscopic remission was not associated with postoperative progression or recurrence,” Shah said. “There are several limitations, including random tissue sampling and sample size. Future studies are required to assess the significance of complete histologic remission on postoperative recurrence and novel treat-to-target endpoints require further investigation in postoperative Crohn’s disease.”
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Shah RS, et al. Histologic activity does not predict future recurrence in postoperative Crohn’s disease. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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