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American Journal of Gastroenterology July 2020

In postoperative Crohn’s disease, an endoscopic score incorporating disease activity in anastomotic site as well as neo-terminal ileum can better predict recurrence

Pal P, MD,MRCP, reviewing Hammoudi N et al (REMIND group) in American Journal of Gastroenterology July 2020

Early ileo-colonoscopy within first year of surgery in a case of Crohn’s disease (CD) can help detect early post operative recurrence of CD by the help of Rutgreet’s score which assess endoscopic activity mainly at anastomotic site. The REMIND group in France has conducted a multi-centre study of 193 patients with median follow up of 3.8 years after surgery of ileal /ileo-colonic CD. Clinical recurrence free survival was significantly lower in patients with ileal lesions compared to no ileal lesions (although the severity of ileal recurrence did not significantly correlate with recurrence free survival). Patients with exclusively ileal disease had poorer clinical outcomes compared to exclusively anastomotic disease. So the study concludes that an endoscopic score comprising of both ileal and colonic disease could be more helpful in predicting post operative recurrence in CD and predict clinical outcomes. As recurrence free survival was lower in ileal disease irrespective of endoscopic severity, even mild ileal disease may benefit from step up approach to improve clinical outcomes.

This study signifies the role of assessment of ileal lesions during early ileo-

colonoscopy after surgery in Crohn’s disease. An endoscopic score incorporating

both anastomotic and ileal disease is needed as better predictors of postoperative

recurrence of CD is warranted. Recent studies (Sokol H, Gut, March 2020) have also shown that prominence of ileal mucosa associated microbiota can predict

postoperative course and recurrence of CD.

Hammoudi N, Auzolle C, Tran Minh ML, et al. Postoperative Endoscopic Recurrence on the Neoterminal Ileum But Not on the Anastomosis Is Mainly Driving Long-Term Outcomes in Crohn's Disease. Am J Gastroenterol. 2020;115(7):1084-1093. doi:10.14309/ajg.0000000000000638


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