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A high CRP before surgery and early medical prophylaxis predict postoperative endoscopic Crohn’s disease recurrence

Sooben, S., Thin, L., Picardo, S., Mckinnon, B., Ryan, J. and Wallace, M.H. (2018) A high CRP before surgery and early medical prophylaxis predict postoperative endoscopic Crohn’s disease recurrence. Journal of Crohn's and Colitis, 12 (Supp. 1). S465-S466.

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Early postoperative endoscopic recurrence (EPER)within the first year after a Crohn’s disease (CD) resection can be as high as 90%. Established risk factors include smoking, previous resections, perforating disease, extent of resection and the presence of myenteric plexitis. Equivocal data exist, however, on the impact that the type of surgical anastomosis or the early use of medical prophylaxis has on the incidence of EPER. Our primary aim was to evaluate whether the type of anastomosis and the early use of biologic/immunosuppressant modified the risk of developing EPER.

This was a retrospective cohort study of Western Australian CD patients who had an ileo-colic resection from January 2012 to June 2017 across two tertiary centres. Included subjects had no macroscopic evidence of residual disease and had a colonoscopy within 12 months of surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥ i2. Variables examined included the type of surgical anastomosis, the presence of at least one high-risk factor (smoking, perforating disease and/or a previous bowel resection), disease duration, peak CRP within 3 months of surgery, presence of histological inflammation at the resection margin, length of bowel resected and the early commencement of medical prophylaxis before the first colonoscopy. Univariate analyses were assessed by Fisher’s exact test. Significant co-variates were examined by logistic regression analysis.

The mean age of the cohort (n = 97) was 43 years. (19–80) and 53% were males. 75.3% had at least one high-risk factor. Overall, 49.5% had endoscopic recurrence. 54.5% had an end to end anastomosis. Univariate analysis showed that histologically active inflammation at the resection margin [33.3% (i2) vs. 12.2% (i0 or1), p = 0.02], and a peak CRP >110 mg/l within 3 months of the resection [62.5% (i2) vs. 34.7% (i0 or 1), p = 0.008] led to a higher incidence of EPER. The early use of medical prophylaxis was associated with a lower EPER incidence [39.6% (i2) vs. 65.3% i0 or 1, p = 0.02]. Multivariate analysis that adjusted for significant covariates revealed the independent predictors for EPER were, a peak CRP >110 [OR = 4.7, 95% CI (1.7–12.9), p = 0.003] and early use of a biologic/immunosuppressant [OR=0.4, 95% CI (0.14–0.9), p = 0.03]. There was a non- statistically significant trend in favour of those that had a side-side or end-side anastomosis for having a lower risk of EPER [OR=0.4,95% CI (0.13–1.00),p = 0.05]. The median time to commencing a biologic or immunosuppressant was 7 weeks.

Early commencement of a biologic or an immunosuppressant after CD surgery is associated with a lower risk of EPER and should be recommended in those with a CRP >110 mg/l preceding surgery, or any established risk factor.

Item Type: Journal Article
Murdoch Affiliation(s): Institute for Immunology and Infectious Diseases
Publisher: Elsevier B.V.
Copyright: © 2018 European Crohn’s and Colitis Organisation (ECCO)
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