Multiple factors, including smoking and perianal disease, increase the likelihood of endoscopic postoperative recurrence in Crohn’s disease.
“The American Gastroenterological Association stated in 2020 that high-risk factors for [Crohn’s disease] recurrence after enterectomy included age at diagnosis of [less than] 30 years, active smoking, and two or more surgeries for penetrating disease with or without a surgical history of perianal disease, while low-risk factors included age at diagnosis of [more than] 50 years, non-smoking, and disease duration of [more than] 10 years,” Lili Yang, PhD, and colleagues wrote. “However, the relative impact of individual risk factors is not explained, and there is a lack of systematic evaluation and clinical decisions to validate these risk factors.”
For a study published in BMC Gastroenterology, Dr. Yang and colleagues conducted a systematic review and meta-analysis to determine risk factors for endoscopic postoperative recurrence (ePOR) in patients with Crohn’s disease. The researchers examined PubMed, Embase, Cochrane Library, and Web of Science databases for relevant literature published from inception through mid-October 2023.
Five Factors Highly Predictive of Postop Recurrence
Dr. Zhang and colleagues reviewed 23 papers, including five case-control studies and 18 cohort studies. The majority were rated as good by the NIH quality assessment tool.
Study sizes ranged from 40 patients to 346, and the number of patients with ePOR ranged from 23 to 169. The ages of the various study populations ranged from 24 to 49.
Findings from the multivariate meta-analysis showed that the following were risk factors for ePOR in patients with Crohn’s disease:
- Smoking: OR=2.06; 95% CI, 1.65-2.57 (P<0.001)
- Prior ileocolonic resection: OR=1.71; 95% CI, 1.23-2.38 (P=0.002)
• Disease localization at ileocolic resection: OR=2.68; 95% CI, 1.38-5.22 (P=0.004)
• Perianal disease: OR=1.47; 95% CI, 1.07-2.03 (P=0.017)
• Anastomotic scattered ulcer: OR=3.39; 95% CI, 1.83-6.28 (P=0.001)
The administration of prophylactic medication postoperatively was shown to protect against ePOR in patients with Crohn’s disease (OR=3.39; 95% CI, 1.83-6.28; P=0.001).
Incorporating Risk Factors In Clinical Practice
In their conclusion, Dr. Zhang and colleagues suggested that clinicians refine existing risk evaluation measurements to include the risk factors for ePOR in Crohn’s disease identified in this study.
They also wrote: “Our understanding of the causes of [Crohn’s disease] recurrence [are] still insufficient, and more prospective, large-sample studies are needed to explore the risk factors for postoperative recurrence.”
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