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. An electronic-based survey was sent to members of the Association of Coloproctology of Great Britain and Ireland and the Irish Society of Gastroenterology. 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). 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.
Ireland ->
University College Dublin ->
PubMed
P Ronan O'Connell,
Glen A Doherty,
John P Burke
