Review
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2014; 20(39): 14393-14406
Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14393
Predictors of recurrence of Crohn’s disease after ileocolectomy: A review
Tara M Connelly, Evangelos Messaris
Tara M Connelly, Evangelos Messaris, Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States
Author contributions: Both authors contributed equally to the research and writing of this manuscript as well as the final approval of the manuscript.
Correspondence to: Evangelos Messaris, MD, PhD, Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, H-137, PO Box 850, Hershey, PA 17033, United States. emessaris@hmc.psu.edu
Telephone: +1-717-5315164 Fax: +1-717-5310646
Received: February 12, 2014
Revised: May 8, 2014
Accepted: June 20, 2014
Published online: October 21, 2014
Processing time: 250 Days and 16.6 Hours
Abstract

Recurrence after ileocolectomy for Crohn’s disease (CD) is common and occurs in up to 80% of patients. Such recurrence can result in repeated surgical interventions, an increased need for medical treatment and, frequently, an impaired quality of life. The aim of this overview is to provide a summary of the factors associated with disease recurrence after ileocolectomy for CD. Recurrence can be measured clinically or endoscopically using established scoring systems. Radiology and serologic tests can also be used, oftentimes in conjunction with endoscopy and/or clinical findings. Many patient and operative factors as well as pharmacologic treatments have been studied as potential predictors of recurrence. Of these, only smoking and immunomodulatory or biologic medical treatment have repeatedly been shown to effect recurrence. Genetic predictors have been studied and suggested but further evaluation in larger cohorts is necessary. This paper highlights validated, reproducible scoring systems for recurrence and the key findings of studies including patient demographics, operative techniques, various pharmacological treatments and histological findings as predictors of recurrence post ileocolectomy in CD.

Keywords: Crohn’s disease; Ileocolectomy; Recurrence; Surgical genetics; Inflammatory bowel disease

Core tip: Disease recurrence after ileocolectomy for Crohn’s disease is common. Studies have been very heterogenous in defining recurrence as it can be clinical, endoscopic, radiologic or serologic. Of the potential predictive factors studied, smoking has been consistently demonstrated to increase the risk of recurrence. While immunomodulator and biologic medical treatment have been shown to increase the time between surgery and recurrence and may decrease overall risk. Genetic predictors have been suggested but further evaluation in large groups is needed. Several other demographic and operative factors have been studied. However, none have been consistently shown to affect recurrence risk.