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Early Diagnosis and Treatment of Postoperative Endoscopic Recurrence of Crohn’s Disease: Partial Benefit by Infliximab—A Pilot Study

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Abstract

Background

Current data indicate that infliximab—given immediately after surgery—may be very effective in preventing postsurgical recurrence of Crohn’s disease. However, it is unknown whether a similar benefit would result from early diagnosis and treatment, rather than prevention of endoscopic recurrence.

Aims

The primary outcome of this study was to clarify whether infliximab, given after diagnosis of postoperative endoscopic recurrence of Crohn’s diseases (Rutgeerts score ≥ 2) can induce endoscopic remission (score <2) at 54 weeks. The secondary outcomes were improvement in the endoscopic score and clinical recurrence at 54 weeks.

Methods

In this prospective open label multicenter pilot study 43 patients with ileocolonic Crohn’s disease subjected to curative surgery underwent colonoscopy 6 months after surgery. Patients with endoscopic recurrence (Rutgeerts score ≥2) were treated with either mesalamine 800 mg tid or infliximab 5 mg/kg bw on a maintenance basis. Colonoscopy was performed after 54 weeks of therapy.

Results

A total of 24/43 patients were diagnosed with endoscopic recurrence at 6 months. Thirteen were treated with infliximab and 11 with mesalamine. None of the 11 mesalamine-treated patients had endoscopic remission at 54 weeks. Two had clinical recurrence at 8 and 9 months. Fifty-four percent of patients treated with infliximab had endoscopic remission at 54 weeks (P = 0.01) while 69% had an improvement in the endoscopic score. None had clinical recurrence.

Conclusions

Treatment of postsurgical endoscopic lesions by infliximab appears superior to mesalamine. However, a sizeable proportion of patients did not fully benefit from this strategy.

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Conflict of interest

D. Sorrentino: advisory board, consultant and research grants from Schering-Plough-Merck, Centocor, Abbott, Roche, Giuliani and UCB Pharma. G. Zoli: advisory board and consultant for Schering-Plough-Merck. W. Fries: advisory board and research grants from Schering-Plough-Merck; advisory board for Abbott. S. Danese: advisory board, consultant and research grants from Schering-Plough-Merck, Centocor, Abbott, UCB Pharma, Ferring and Takeda. The other authors have no potential conflicts of interest to disclose. This study was not sponsored by the pharmaceutical industry.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Pathology, University of Udine School of Medicine, Udine, Italy

    Dario Sorrentino, Alberto Paviotti & Dimitra Zarifi

  2. Department of Digestive Surgery, University of Udine School of Medicine, Udine, Italy

    Giovanni Terrosu

  3. MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK

    Marco Geraci

  4. Department of Pathology, University of Udine School of Medicine, Udine, Italy

    Claudio Avellini

  5. Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy

    Giorgio Zoli

  6. Department of Internal Medicine and Medical Therapy, University of Messina, Messina, Italy

    Walter Fries

  7. Division of Gastroenterology, Istituto Clinico Humanitas-Rozzano, Milan, Italy

    Silvio Danese

  8. Department of Gastroenterology and Digestive Endoscopy, Borgomanero—ASL Novara, Novara, Italy

    Pietro Occhipinti

  9. Division of Internal Medicine, Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Pordenone

    Tiziano Croatto

  10. Cattedra di Gastroenterologia, Pad. Scrosoppi, Via Colugna, Udine, 33100, Italy

    Dario Sorrentino

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  1. Dario Sorrentino
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  2. Giovanni Terrosu
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  7. Walter Fries
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  8. Silvio Danese
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  10. Tiziano Croatto
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  11. Dimitra Zarifi
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Correspondence to Dario Sorrentino.

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Sorrentino, D., Terrosu, G., Paviotti, A. et al. Early Diagnosis and Treatment of Postoperative Endoscopic Recurrence of Crohn’s Disease: Partial Benefit by Infliximab—A Pilot Study. Dig Dis Sci 57, 1341–1348 (2012). https://doi.org/10.1007/s10620-011-2025-z

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  • DOI: https://doi.org/10.1007/s10620-011-2025-z

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