Pediatric Crohn's disease: Risk factors for postoperative recurrence

OBJECTIVE: Postoperative recurrence of Crohn's disease in adults has been e xtensively studied; however, the course of Crohn's disease after surgery in children has not been well defined. The aim of this study was to examine t he postoperative course of pediatric Crohn's disease and the factors that m ay predict early postoperative recurrence. METHODS: We identified 100 resective surgeries in 79 children with Crohn's disease seen at the Children's Hospital of Philadelphia between 1978 and 19 96. A retrospective, multivariable analysis of factors potentially influenc ing postoperative clinical recurrence was performed. Preoperative and posto perative height measurements were compared, and z scores were computed for height-for-age. Two-tailed t test was used for the analysis. RESULTS: Clinical recurrence rates were 17% at 1 yr, 38% at 3 yr, and 60% a t 5 yr. Patients with colonic Crohn's disease had a significantly shorter p ostoperative recurrence-free interval (median 1.2 yr) than patients with il eocecal (median 4.4 yr) or diffuse disease (median 3.0 yr) (p = 0.01). On m ultivariable analysis, a high Pediatric Crohn's Disease Activity Index at t he time of surgery (p = 0.01) and preoperative use of 6-mercaptopurine (6-M P) (p < 0.005) were also independently associated with higher postoperative recurrence rates. There was a significant improvement in z scores for heig ht (p = 0.04) after surgery. CONCLUSIONS: In children undergoing resective surgery for Crohn's disease, high rates of postoperative Crohn's disease recurrence are associated with severe disease at the time of surgery, colonic Crohn's disease, and the pre operative use of 6-MP. Patients who require preoperative use of 6-MP are li kely to suffer from a more aggressive disease and would benefit from postop erative 6-MP prophylaxis. Height growth was improved after intestinal resec tion for Crohn's disease. <(c)> 2001 by Am. Cell, of Gastroenterology.