The Crohn’s Disease-Ulcerative Colitis Clinical AppraisalPart II

Academic Content

Publication Overview Introduction Navigating this Publication See Part I

Step 1 -

Rationale and Definition

Step 2 -

International Clinician Survey Results

Step 3 -

Data Review and Faculty Summary

Step 4 -

International and Faculty Survey Comparison and Faculty Discussion

Step 5 -

Dr. Travis’ Observed Future Directions and References

Faculty Presentations

Statement 1 Statement 2 Statements
3a and 3b Statement 4 Statement 5 Statement 6 Statement 7 Statement 8

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Clinical Gastroentrology and Hepatology

Dr. Travis’ Observed Future Directions

Reassessment and training in the application of the Rutgeerts’ postoperative endoscopic index is fundamental. The results of 3 large trials on postoperative management (POCER, PREVENT, and TOPPIC)^6,20,21 will redefine the frequency of endoscopic recurrence and, more importantly, its implications. Until that time, smoking cessation, colonoscopic assessment within the first year after ileocolic resection, and then the prophylactic treatment best suited to the individual patient are the standard of care.¹

References

[1]

Van Assche G, Dignass A, Reinisch W, et al; European Crohn's and Colitis Organisation (ECCO. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations. J Crohns Colitis 2010;4:63-101.

[2]

Rutgeerts P, Geboes K, Vantrappen G, et al. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990;99:956-963.

[3]

Renna S, Camma C, Modesto I, et al. Meta-analysis of the placebo rates of clinical relapse and severe endoscopic recurrence in postoperative Crohn's disease. Gastroenterology 2008;135:1500-1509.

[4]

Doherty G, Bennett G, Patil S, et al. Interventions for prevention of post-operative recurrence of Crohn's disease. Cochrane Database Syst Rev. 2009(4):CD006873.

[5]

Regueiro M, Schraut W, Baidoo L, et al. Infliximab prevents Crohn's disease recurrence after ileal resection. Gastroenterology 2009;136:441-450.

[6]

ClinicalTrials.gov. A multicenter trial comparing REMICADE (infliximab) and placebo in the prevention of recurrence in Crohn's disease (CD) patients undergoing surgical resection who are at an increased risk of recurrence. NCT01190839. Last updated January 5, 2016. Available at https://clinicaltrials.gov/ct2/show/results/NCT01190839. Accessed March 2, 2016.

[7]

Lochs H, Mayer M, Fleig WE, et al. Prophylaxis of postoperative relapse in Crohn's disease with mesalamine: European Cooperative Crohn's Disease Study VI. Gastroenterology 2000;118:264-273.

[8]

van Loo ES, Dijkstra G, Ploeg RJ, et al. Prevention of postoperative recurrence of Crohn's disease. J Crohns Colitis 2012;6:637-646.

[9]

Rutgeerts P, Hiele M, Geboes K, et al. Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection. Gastroenterology 1995;108:1617-1621.

[10]

Rutgeerts P, Van Assche G, Vermeire S, et al. Ornidazole for prophylaxis of postoperative Crohn's disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2005;128:856-861.

[11]

Hanauer SB, Korelitz BI, Rutgeerts P, et al. Postoperative maintenance of Crohn's disease remission with 6-mercaptopurine, mesalamine, or placebo: A 2-year trial. Gastroenterology 2004;127:723-729.

[12]

Ardizzone S, Maconi G, Sampietro GM, et al. Azathioprine and mesalamine for prevention of relapse after conservative surgery for Crohn's disease. Gastroenterology 2004;127:730-740.

[13]

Reinisch W, Angelberger S, Petritsch W, et al; International AZT-2 Study Group.. Azathioprine versus mesalazine for prevention of postoperative clinical recurrence in patients with Crohn's disease with endoscopic recurrence: efficacy and safety results of a randomised, double-blind, double-dummy, multicentre trial. Gut 2010;59:752-759..

[14]

Manosa M, Cabre E, Bernal I, et al. Addition of metronidazole to azathioprine for the prevention of postoperative recurrence of Crohn's disease: A randomized, double-blind, placebo-controlled trial. Inflamm Bowel Dis. 2013;19:1889-1895.

[15]

Yoshida K, Fukunaga K, Ikeuchi H, et al. Scheduled infliximab monotherapy to prevent recurrence of Crohn's disease following ileocolic or ileal resection: A 3-year prospective randomized open trial. Inflamm Bowel Dis. 2012;18:1617-1623.

[16]

Regueiro M, Kip KE, Baidoo L, et al. Postoperative therapy with infliximab prevents long-term Crohn's disease recurrence. Clin Gastroenterol Hepatol. 2014;12:1494-1502. NCT01190839

[17]

Regueiro M, Feagan B, Zou B, et al. Infliximab for prevention of recurrence of post-surgical Crohn's disease following ileocolonic resection: A randomized, placebo-controlled study. Gastroenterology 2015;148:S-141.

[18]

Savarino E, Bodini G, Dulbecco P, et al. Adalimumab is more effective than azathioprine and mesalamine at preventing postoperative recurrence of Crohn's disease: a randomized controlled trial. Am J Gastroenterol. 2013;108:1731-1742.

[19]

Papamichael K, Archavlis E, Lariou C, et al. Adalimumab for the prevention and/or treatment of post-operative recurrence of Crohn's disease: A prospective, two-year, single center, pilot study. J Crohns Colitis 2012;6:924-931.

[20]

De Cruz P, Kamm MA, Hamilton AL, et al. Crohn's disease management after intestinal resection: a randomised trial. Lancet 2015;385:1406-1417.

[21]

ISRCTN Registry. Randomised controlled trial of 6-Mercaptopurine (6MP) versus placebo to prevent recurrence of Crohn's disease following surgical resection. Last updated January 12, 2015. Available at http://www.isrctn.com/ISRCTN89489788. Accessed March 2, 2016.

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