Recurrence patterns after first resection for stricturing or penetrating Crohn's disease
Article first published online: 19 FEB 2009
Copyright © 2009 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 15, Issue 7, pages 1071–1075, July 2009
How to Cite
Sachar, D. B., Lemmer, E., Ibrahim, C., Edden, Y., Ullman, T., Ciardulo, J., Roth, E., Greenstein, A. J. and Bauer, J. J. (2009), Recurrence patterns after first resection for stricturing or penetrating Crohn's disease. Inflamm Bowel Dis, 15: 1071–1075. doi: 10.1002/ibd.20872
- Issue published online: 10 JUN 2009
- Article first published online: 19 FEB 2009
- Manuscript Accepted: 4 DEC 2008
- Manuscript Received: 2 DEC 2008
- Regional Grant-in-Aid from Procter & Gamble Pharmaceuticals
- Burrill B. Crohn Research Foundation, Inc.
Background: Crohn's disease (CD) usually recurs after resection, but the factors associated with this risk remain obscure. We set out to determine the role of stricturing (Montreal Classification B2) versus penetrating (Classification B3) disease behavior in predicting early (<3 years) versus late (≥3 years) postoperative recurrence.
Methods: We identified a cohort of 34 patients seen at The Mount Sinai Hospital who had undergone a first ileocolic resection prior to December 31, 2004, who had been clinically thought to have had stricturing (B2) disease, and for whom we could verify 1) the operative and surgical pathology findings; and 2) the time of onset of symptoms attributable to recurrent CD by endoscopy, radiology, or surgery. Cases were reclassified as either “stricturing” (B2) or “penetrating” (B3) on the basis of operative and surgical pathology reports. Recurrences were classified as either “early” (<3 years) or “late” (≥3 years) depending on the first appearance of postoperative symptoms that were verified endoscopically and histologically, radiologically, or surgically as being attributable to anastomotic recurrence of the CD.
Results: Among these 34 patients clinically thought to have had B2 disease, 12 had B2 disease confirmed upon review of surgical and pathology reports and none of them had recurrence within 3 years. Among the 22 patients reclassified as B3 disease, 12 (55%) had early recurrence. This difference was significant at the 0.002 level by the Fisher Exact Test.
Conclusions: There is a strong proclivity for early postoperative recurrence of penetrating CD compared to stricturing disease, which may not be evident by behavioral classification on clinical grounds alone. Patients with confirmed uncomplicated stricturing obstruction at their first resection seem unlikely to experience a clinical recurrence within the next 3 years.
(Inflamm Bowel Dis 2009)