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Background <p>Crohn’s disease (CD) is characterized by recurrence following surgical resection. We assessed the post-operative recurrence rates, plausible risk factors and the prophylactic measures for prevention of the same.</p> Methods <p>This retrospective cohort included CD patients who underwent ileocolic resection from 2005 to 2021 with ≥ 1&#xa0;year follow‑up to evaluate the association between post-operative endoscopic surveillance and recurrence‑free survival. Surveillance patients were matched 1:1 to non‑surveillance controls using nearest‑neighbor propensity scores estimated from a logistic regression model that included age, sex, smoking, disease behavior and location, surgical approach, appendectomy history, prior anti-tubercular therapy and pre-operative prophylaxis (caliper = 0.20 SD of the logit; no replacement). Recurrence-free survival was analyzed by Kaplan-Meier curves, log-rank test and adjusted hazard ratios from multi-variable Cox regression.</p> Results <p>Of 90 patients (60% male; median follow‑up 45&#xa0;months, interquartile range (IQR) 20.75–72), ileal stricturing disease predominated; clinical recurrence occurred in 51% (median recurrence‑free survival 61&#xa0;months). One and three‑year clinical recurrence rates were 23.3% and 36.3%, respectively; one and three‑year endoscopic recurrence rates were 30.1% and 42.8%, respectively. In the propensity‑matched cohort, endoscopic surveillance was associated with a 34% relative reduction in the hazard of clinical recurrence (HR 0.66; 95% CI 0.32–1.38). Surveillance‑guided prophylaxis achieved 81.3% recurrence‑free survival at 24&#xa0;months. Active smoking independently increased endoscopic recurrence risk (HR 2.96; 95% CI 1.18–7.38; <i>p</i> &lt; 0.001).</p> Conclusion <p>Endoscopy-driven post-operative surveillance with timely initiation or escalation of prophylaxis and smoking cessation was associated with longer recurrence‑free survival.</p> Graphical Abstract <p></p>

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Incidence, risk factors and preventive strategies for post-operative recurrence of Crohn’s disease: A retrospective propensity-matched cohort analysis

  • 期刊论文

  • 发表日期：

    2026年1月17日

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  • Pratheek Choppala,
  • David Mathew Thomas,
  • Upendra Baitha,
  • Sandeep Kumar Mundhra,
  • Peeyush Kumar,
  • Himanshu Narang,
  • KJDB Shankar,
  • Umang Arora,
  • Rajesh Panwar,
  • Nihar Ranjan Dash,
  • Sujoy Pal,
  • Peush Sahni,
  • Raju Sharma,
  • Govind Makharia,
  • Saurabh Kedia,
  • Vineet Ahuja

摘要

Background

Crohn’s disease (CD) is characterized by recurrence following surgical resection. We assessed the post-operative recurrence rates, plausible risk factors and the prophylactic measures for prevention of the same.

Methods

This retrospective cohort included CD patients who underwent ileocolic resection from 2005 to 2021 with ≥ 1 year follow‑up to evaluate the association between post-operative endoscopic surveillance and recurrence‑free survival. Surveillance patients were matched 1:1 to non‑surveillance controls using nearest‑neighbor propensity scores estimated from a logistic regression model that included age, sex, smoking, disease behavior and location, surgical approach, appendectomy history, prior anti-tubercular therapy and pre-operative prophylaxis (caliper = 0.20 SD of the logit; no replacement). Recurrence-free survival was analyzed by Kaplan-Meier curves, log-rank test and adjusted hazard ratios from multi-variable Cox regression.

Results

Of 90 patients (60% male; median follow‑up 45 months, interquartile range (IQR) 20.75–72), ileal stricturing disease predominated; clinical recurrence occurred in 51% (median recurrence‑free survival 61 months). One and three‑year clinical recurrence rates were 23.3% and 36.3%, respectively; one and three‑year endoscopic recurrence rates were 30.1% and 42.8%, respectively. In the propensity‑matched cohort, endoscopic surveillance was associated with a 34% relative reduction in the hazard of clinical recurrence (HR 0.66; 95% CI 0.32–1.38). Surveillance‑guided prophylaxis achieved 81.3% recurrence‑free survival at 24 months. Active smoking independently increased endoscopic recurrence risk (HR 2.96; 95% CI 1.18–7.38; p < 0.001).

Conclusion

Endoscopy-driven post-operative surveillance with timely initiation or escalation of prophylaxis and smoking cessation was associated with longer recurrence‑free survival.

Graphical Abstract