Male gender, active smoking and previous intestinal resection are risk factors for post‐operative endoscopic recurrence in Crohn's disease: results from a prospective cohort study

Summary Background After ileocaecal resection for Crohn's disease ( CD ), inflammatory lesions frequently recur on the anastomosis and/or on the neo‐terminal ileum. Aim To identify predictors of early post‐operative endoscopic recurrence. Methods From September 2010 to September 2017, the REMIND group conducted a prospective nationwide study in nine French academic centres. Data were collected at the time of surgery and endoscopy, performed 6‐12 months after surgery. Endoscopic recurrence was defined as a Rutgeerts score ≥i2. Baseline factors associated with endoscopic recurrence were searched by univariate and multivariate regression analysis. Results Two hundred and eighty‐nine CD patients were included. Endoscopy within 1 year following surgery was performed in 225 (78%) patients (104M/121F). Mean age and disease duration were 35 (12.2) and 8.8 (8.9) years respectively. Seventy (32%) patients were active smokers at surgery. One hundred and forty‐two (63%) patients received at least one anti‐ TNF therapy before surgery. After surgery, 40 (18%) patients received thiopurines and 66 (29%) received an anti‐ TNF agent. Endoscopic recurrence occurred in 107 (47%) patients. In multivariate analysis, male gender ( OR = 2.48 [ IC 95% 1.40‐4.46]), active smoking at surgery ( OR = 2.65 [ IC 95% 1.44‐4.97]) and previous resection ( OR = 3.03 [ IC 95% 1.36‐7.12]) were associated with a higher risk of endoscopic recurrence. Inversely, post‐operative anti‐ TNF treatment decreased the risk of endoscopic recurrence ( OR = 0.50 [ IC 95% 0.25‐0.96]). Conclusions Male gender, active smoking at surgery and previous intestinal resection are associated with a higher risk of endoscopic post‐operative recurrence, while post‐operative anti‐ TNF treatment is associated with a lower risk.