Male gender, active smoking and previous intestinal resection are risk factors for post‐operative endoscopic recurrence in Crohn's disease: results from a prospective cohort study

摘要

Summary Background After ileocaecal resection for Crohn's disease ( CD ), inflammatory lesions frequently recur on the anastomosis and/or on the neo‐terminal ileum. Aim To identify predictors of early post‐operative endoscopic recurrence. Methods From September 2010 to September 2017, the REMIND group conducted a prospective nationwide study in nine French academic centres. Data were collected at the time of surgery and endoscopy, performed 6‐12?months after surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥i2. Baseline factors associated with endoscopic recurrence were searched by univariate and multivariate regression analysis. Results Two hundred and eighty‐nine CD patients were included. Endoscopy within 1?year following surgery was performed in 225 (78%) patients (104M/121F). Mean age and disease duration were 35 (12.2) and 8.8 (8.9) years respectively. Seventy (32%) patients were active smokers at surgery. One hundred and forty‐two (63%) patients received at least one anti‐ TNF therapy before surgery. After surgery, 40 (18%) patients received thiopurines and 66 (29%) received an anti‐ TNF agent. Endoscopic recurrence occurred in 107 (47%) patients. In multivariate analysis, male gender ( OR ?=?2.48 [ IC 95% 1.40‐4.46]), active smoking at surgery ( OR ?=?2.65 [ IC 95% 1.44‐4.97]) and previous resection ( OR ?=?3.03 [ IC 95% 1.36‐7.12]) were associated with a higher risk of endoscopic recurrence. Inversely, post‐operative anti‐ TNF treatment decreased the risk of endoscopic recurrence ( OR ?=?0.50 [ IC 95% 0.25‐0.96]). Conclusions Male gender, active smoking at surgery and previous intestinal resection are associated with a higher risk of endoscopic post‐operative recurrence, while post‐operative anti‐ TNF treatment is associated with a lower risk.