RISK AND SIGNIFICANCE OF ENDOSCOPIC RADIOLOGICAL EVIDENCE OF RECURRENT CROHNS-DISEASE/

Background & Aims: The aim of this study was to determine the risk of endoscopic/radiological recurrence of Crohn's disease postoperatively and the long-term outcome. Methods: A randomized placebo-controlled tr ial was performed to determine the effectiveness of mesalamine in prev enting recurrent Crohn's disease postoperatively. Patients in the cont rol group were examined endoscopically/radiologically before entry int o and annually during the trial. Findings were classified as minimal o r severe. Results: There were 76 patients (49 men and 37 women; mean a ge, 37.1 +/- 13.2 years). Fifty (61.7%) had terminal ileal resections. Overall, 55 endoscopic/radiological recurrences were observed in 51 p atients (67.1%). Expressed actuarially, the recurrence rate was 27.5% at 1 year (95% confidence interval [CI], 15.8%-37.6%), 60.8% at 2 year s (95% CI, 46%-71.3%), and 77.3% at 3 years (95% CI, 62.7%-86.3%). Nin eteen (37%) were symptomatic and 12 (24%) were initially asymptomatic but later became symptomatic (mean, 13.0 +/- 8.8 months), whereas 20 ( 39%) remained asymptomatic (mean, 16.9 +/- 17.4 months). Patients with severe endoscopic/radiological disease were significantly more likely to be or become symptomatic than those with minimal disease (23 of 32 vs. 8 of 19, respectively; P = 0.0437). Conclusions: This study sugge sts that postoperative endoscopic/radiological recurrences occur later than previously reported. Furthermore, many of these patients, especi ally with minimal disease, will remain asymptomatic.