Histologic Activity From Neoterminal Ileal Biopsies in Patients With Crohn's Disease in Endoscopic Remission is Associated With Postoperative Recurrence

Author:

Shah Ravi S.1ORCID,Hu Jessica H.2ORCID,Bachour Salam3ORCID,Joseph Abel4ORCID,Syed Hareem5ORCID,Yang Qijun6ORCID,Hajj Ali Adel5,Li Terry7ORCID,Contreras Sussell8,Pothula Shravya9,Vinaithirthan Vall10,Regueiro Miguel1ORCID,Axelrad Jordan8ORCID,Barnes Edward L.11ORCID,Cohen Benjamin L.1ORCID,Click Benjamin H.12

Affiliation:

1. Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA;

2. University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;

3. Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA;

4. Department of Gastroenterology, Stanford University, Palo Alto, California, USA;

5. Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA;

6. Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA;

7. Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA;

8. Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, New York, USA;

9. Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;

10. University of Colorado School of Medicine, Aurora, Colorado, USA;

11. Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA;

12. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Abstract

INTRODUCTION: Following ileocolic resection (ICR), the clinical importance and prognostic implications of histologic activity on biopsies in Crohn's disease (CD) patients with endoscopic remission are not well defined. The aim of this study was to determine if histologic activity in patients with endoscopic remission is associated with future risk of endoscopic and/or radiologic postoperative recurrence (POR). METHODS: In this multicenter retrospective cohort study, adult patients with CD who underwent ICR between 2009 and 2020 with endoscopic biopsies of ileal mucosa from Rutgeerts i0 on index colonoscopy were included. The composite rate of endoscopic (Rutgeerts score ≥i2b) and radiologic (active inflammation on imaging) recurrence was compared in patients with and without histologic activity using a Kaplan-Meier survival analysis. A multivariable Cox proportional hazard regression model including clinically relevant risk factors of POR, postoperative biologic prophylaxis, and histology activity was designed. RESULTS: A total of 113 patients with i0 disease on index colonoscopy after ICR were included. Of these, 42% had histologic activity. Time to POR was significantly earlier in the histologically active versus normal group (P = 0.04). After adjusting for clinical risk factors of POR, histologic activity (HR 2.37, 95% CI 1.17–4.79; P = 0.02) and active smoking (HR 2.54, 95% CI 1.02–6.33; P = 0.05) were independently associated with subsequent composite POR risk. DISCUSSION: In patients with postoperative CD, histologic activity despite complete endoscopic remission is associated with composite, endoscopic, and radiographic recurrence. Further understanding of the role of histologic activity in patients with Rutgeerts i0 disease may provide a novel target to reduce disease recurrence in this population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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