GIE Associate Editor, Dr. Lisa L. Strate, MD, MPH, highlights this article from the August issue “Differential risk of disease progression between isolated anastomotic ulcers and mild ileal recurrence after ileocolonic resection in patients with Crohn’s disease” by Jacob E. Ollech, MD, et al. 

Crohn’s disease recurrence after ileocolonic resection is a common problem. It is not clear whether ulceration confined to the anastomosis (Rutgeert score i2a), which may be ischemic in nature, has a different prognosis when compared to those confined to the neoterminal ileum (Rutgeert score i2b).  This study adds to the literature outlining the natural history of these 2 groups.

For providers caring for patients with Crohn’s disease, this article helps guide post-operative care in patients undergoing ileocolectomy. This study suggests that patients with ulcers confined to the anastomosis (i2a) are less likely to have disease progression than those with ulcers in the neoterminal ileum (i2b) (hazard ratio 2.4 vs 6.2 when compared to patients with no ulcerations or < 5 ulcerations confined to the terminal ileum [Rutgeert scores i0 and i1]). Therefore, treatment escalation may not be necessary in this subgroup, although future prospective studies are needed to confirm these findings.

Figure 1. Time to endoscopic progression based on Rutgeert score (RS) at the initial postoperative colonoscopy. Kaplan-Meier curves of time from first postoperative colonoscopy to RS of i3 to i4. Blue line, RS 0 to 1; red line, RS 2a; green line, RS 2b.

Read the article abstract here.

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