TY - JOUR
T1 - Risk factors for surgical recurrence after ileocolic resection of Crohn's disease
AU - Unkart, Jonathan T.
AU - Anderson, Lauren
AU - Li, Ellen
AU - Miller, Candace
AU - Yan, Yan
AU - Charles Gu, C.
AU - Chen, Jiajing
AU - Stone, Christian D.
AU - Hunt, Steven
AU - Dietz, David W.
N1 - Funding Information:
This work was supported in part by NIH grant P30 DK52574 (Li), Barnes Jewish Foundation Grant 00434–0805–01 (Dietz/Hunt), Johnson and Johnson Translational Seed Award (Li). L.A. was supported by T35 DK074375. Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 7, 2007. Address of correspondence: David W. Dietz, M.D., Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave., Desk A-30, Cleveland, Ohio 44195. E-mail: [email protected]
PY - 2008/8
Y1 - 2008/8
N2 - PURPOSE: We evaluated the effect of potential clinical factors on surgical recurrence of ileal Crohn's disease after initial ileocolic resection. METHODS: One hundred seventy-six patients with ileal Crohn's disease who underwent an ileocolic resection with anastomosis were identified from our database. The outcome of interest was time from first to second ileocolic resection. Survival analysis was used to assess the significance of the Montreal phenotype classification, smoking habit, a family history of inflammatory bowel disease and other clinical variables. RESULTS: In our final Cox model, a family history of inflammatory bowel disease (hazard ratio 2.24, 95 percent confidence interval 1.16-4.30, P=0.016), smoking at time of initial ileocolic resection (hazard ratio 2.08, 95 percent confidence interval 1.11-3.91, P=0.023) was associated with an increased risk of a second ileocolic resection while postoperative prescription of immunomodulators (hazard ratio 0.40, 95 percent confidence interval 0.18-0.88, P=0.022) was associated with a decreased risk of a second ileocolic resection. CONCLUSIONS: Both a family history of inflammatory bowel disease and smoking at the time of the initial ileocolic resection are associated with an increased risk of a second ileocolic resection. Postoperative prescription of immunomodulators is associated with a reduced risk of surgical recurrence. This study supports the concept that both genetic and environmental factors influence the risk of surgical recurrence of ileal Crohn's disease.
AB - PURPOSE: We evaluated the effect of potential clinical factors on surgical recurrence of ileal Crohn's disease after initial ileocolic resection. METHODS: One hundred seventy-six patients with ileal Crohn's disease who underwent an ileocolic resection with anastomosis were identified from our database. The outcome of interest was time from first to second ileocolic resection. Survival analysis was used to assess the significance of the Montreal phenotype classification, smoking habit, a family history of inflammatory bowel disease and other clinical variables. RESULTS: In our final Cox model, a family history of inflammatory bowel disease (hazard ratio 2.24, 95 percent confidence interval 1.16-4.30, P=0.016), smoking at time of initial ileocolic resection (hazard ratio 2.08, 95 percent confidence interval 1.11-3.91, P=0.023) was associated with an increased risk of a second ileocolic resection while postoperative prescription of immunomodulators (hazard ratio 0.40, 95 percent confidence interval 0.18-0.88, P=0.022) was associated with a decreased risk of a second ileocolic resection. CONCLUSIONS: Both a family history of inflammatory bowel disease and smoking at the time of the initial ileocolic resection are associated with an increased risk of a second ileocolic resection. Postoperative prescription of immunomodulators is associated with a reduced risk of surgical recurrence. This study supports the concept that both genetic and environmental factors influence the risk of surgical recurrence of ileal Crohn's disease.
KW - Crohn's disease
KW - Ileocolic resection
KW - Postoperative recurrence
UR - http://www.scopus.com/inward/record.url?scp=48349146716&partnerID=8YFLogxK
U2 - 10.1007/s10350-008-9348-7
DO - 10.1007/s10350-008-9348-7
M3 - Article
C2 - 18536967
AN - SCOPUS:48349146716
SN - 0012-3706
VL - 51
SP - 1211
EP - 1216
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 8
ER -