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A survey of current practices used to maintain surgically induced remission following intestinal resection for Crohn’s disease

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Post-operative Crohn’s disease (CD) recurrence is common after intestinal resection. The European Crohn’s and Colitis Organization has issued guidelines regarding the optimal post-operative management of patients who have undergone intestinal resection for CD. The current study aims to assess the current adjuvant therapy practices of colorectal surgeons and gastroenterologists.

Methods

An electronic-based survey was sent to members of the Association of Coloproctology of Great Britain and Ireland and the Irish Society of Gastroenterology.

Results

One hundred twenty-five surgeons and gastroenterologists responded. Gastroenterologists more frequently assessed for pre-clinical recurrence with serum inflammatory markers (97 vs. 51 %, P < 0.001), faecal calprotectin (30 vs. 10 %, P = 0.008) and ileocolonoscopy (67 vs. 23 %, P < 0.001), while surgeons more frequently performed a CT scan (23 vs. 6 %, P = 0.037). The majority of respondents estimated the 1-year endoscopic recurrence to be 10–25 %, and 36 % of respondents offered prophylaxis to all post-operative patients. Budesonide (8 vs. 4 %, P = 0.006) and azathioprine/mercaptopurine (60 vs. 33 %, P < 0.001) were more often prescribed for high-risk patients, while imidazole antibiotics (11 vs. 5 %, P < 0.001) and 5-ASA derivatives were more often prescribed for low-risk patients (51 vs. 14 %, P < 0.001).

Conclusion

Currently, surgeons and gastroenterologists involved in the peri-operative care of patients with CD underestimate the risk of recurrence following intestinal resection and under-utilize ileocolonoscopy to tailor adjuvant therapy.

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Acknowledgments

The authors would like to thank Ms Anne O’Mara of the ACPGBI for providing access to the association mailing list and Mr Michael Dineen of the ISG for forwarding the Society members the presented survey.

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Authors and Affiliations

  1. Department of Colorectal Surgery, St Vincent’s University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

    John P. Burke & P. Ronan O’Connell

  2. Department of Gastroenterology, St Vincent’s University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

    Glen A. Doherty

  3. Centre for Colorectal Disease, St Vincent’s University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland

    John P. Burke, Glen A. Doherty & P. Ronan O’Connell

  4. Surgical Professorial Unit, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    John P. Burke

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  1. John P. Burke
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Correspondence to John P. Burke.

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Burke, J.P., Doherty, G.A. & O’Connell, P.R. A survey of current practices used to maintain surgically induced remission following intestinal resection for Crohn’s disease. Int J Colorectal Dis 28, 1073–1079 (2013). https://doi.org/10.1007/s00384-013-1668-y

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