IMPORTANCE OF ENDOSCOPICALLY VISUALIZED RECURRENT ILEITIS AND SMALL-BOWEL RESECTION FOR SYMPTOMS IN CROHNS-DISEASE

Background: The relationship between the endoscopic appearance of the ileal mucosa in Crohn's disease and the symptoms has not been studied. Although surgery is important, morbidity caused by intestinal resecti ons and its relation to recurrent inflammation have been poorly evalua ted. Methods. The relationship of symptoms to various ileoscopic signs of inflammation and previous intestinal resection was prospectively s tudied in 75 postresection Crohn patients. Results: Multivariate analy sis showed that a combination of anastomotic width, pus, and length of previous small-bowel resection best explained a symptom score (r = 0. 53, p < 0.001). Of 40 patients with the anastomosis strictured to less than 15 mm, only 9 had moderate to severe symptoms. Patients with a s tricture diameter < 10 mm differed significantly in symptom score (p < 0.05) from those with wider anastomoses. Conclusions: The study indic ated that intestinal resection was as important for symptoms as endosc opically viewed recurrent ileal inflammation. The diameter at which an intestinal stricture produces symptoms is less than previously argued , and the association of small-bower resection with symptoms underline s the advisability of minimal surgery.