P0736 Analysis of endoscopic recurrence risk factors in Crohn's disease after surgical treatment within 1 year
Authors: Wei T , Guo H , Xiaomei S , Le H 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) treatment options are increasingly available, but there is still no definitive cure. It is estimated that 40% of IBD patients do not respond to treatment, about 80% of Crohn's disease (CD) patients will require surgery in their lifetime, and 50% of patients experience endoscopic recurrence within one year after surgery. This article aims to explore the risk factors for postoperative recurrence in CD, predictive indicators of recurrence, and prevention of recurrence, as well as how patients can better manage themselves after surgery.

Methods
A retrospective analysis was conducted on the clinical data of 72 patients with Crohn's disease who underwent intestinal resection surgery. All patients underwent endoscopic re examination one year after surgery and were divided into a non recurrence group of 43 cases and a recurrence group of 29 cases based on the Rutgeerts score. Use logistic regression analysis to identify the relevant risk factors for postoperative recurrence.

Results
Univariate analysis revealed that endoscopic recurrence was associated with smoking (OR 5.226, 95% CI 1.073-25.457, P=0.041), penetrating lesions (OR 5.25, 95% CI 1.052-26.197, P=0.043), small intestine resection (OR 3.088, 95% CI 1.064-8.966, P=0.038), preoperative high CRP (OR 1.029, 95% CI 1.001-1.029, P=0.045), and the presence of visceral obesity during surgery (OR 7.536, 95% CI 1.979-28.692, P=0.03). Multivariate regression analysis showed that visceral obesity is an independent risk factor for endoscopic recurrence in patients undergoing Crohn's disease surgery (OR 5.925, 95% CI 1.167-30.087, P=0.032). However, the patient's gender, BMI at the time of surgery, muscular dystrophy, presence of anal fistula, history of previous intestinal surgery, and the course of the disease during this surgery were not found to be related to postoperative recurrence.

Conclusion
Patients with Crohn's disease who undergo laparoscopic intestinal resection and have visceral obesity during surgery have a higher risk of endoscopic recurrence one year after surgery. These patients need close follow-up and timely adjustment of medication to control the risk of recurrence.

References
1.Katz S. "Mind the gap": an unmet need for new therapy in IBD. J Clin Gastroenterol. 2007;41(9):799-809. doi:10.1097/ MCG.0b013e318033d71d
2.Kayal M, Posner H, Spencer E, Colombel JF, Stalgis C, Ungaro RC. Net remission rates with biologic and small molecule treatment in ulcerative colitis: a reappraisal of the clinical trial data. Clin Gastroenterol Hepatol. Published online January 12, 2023. doi:10.1016/j.cgh.2023.01.005
3.TASNEEM A, FLORIAN R, CLAUDIO F, et al. Pathogenesis of postoperative recurrence in Crohn's disease.[J]. Gut, 2011,60(4)
4.SOLBERG I C, CVANCAROVA M, VATN M H, et al. Risk matrix for prediction of advanced disease in a population-based study of patients with Crohn’s disease (the IBSEN Study)[J]. Inffamm Bowel Dis, 2014, 20(1): 60-68.
5.REGUEIRO M, KIP K E, BAIDOO L, et al. Postoperative therapy with infliximab prevents long-term Crohn’s disease recurrence[J]. Clin Gastroenterol Hepatol, 2014, 12(9): 1494-1502.
6.Donnellan CF, Yann LH, Lal S. Nutritional management of Crohn’s disease. Therap Adv Gastroenterol. (2013) 6:231–42. doi: 10.1177/1756283X13477715
7.Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol. (2009) 15:2570–8. doi: 10.3748/wjg.15.2570
8.Van Assche G, Dignass A, Panes J, et al. European Crohn’s and Colitis Organisation (ECCO). The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis 2010;4(1):7-27
9.朱维铭，李 毅，余 超，等． 肠部分切除后吻合方式对克罗 恩病术后复发的影响． 中华胃肠外科杂志，2011，14( 3) : 168- 170.
10.Kullberg J, Brandberg J, Angelhed J E, et al. Whole-body adipose tissue analysis: Comparison of MRI, CT and dual energy X-ray absorptiometry[J]. Br J Radiol, 2009,82(974):123-130.