Digestive Diseases and Sciences

, Volume 57, Issue 5, pp 1341–1348 | Cite as

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

  • Dario Sorrentino
  • Giovanni Terrosu
  • Alberto Paviotti
  • Marco Geraci
  • Claudio Avellini
  • Giorgio Zoli
  • Walter Fries
  • Silvio Danese
  • Pietro Occhipinti
  • Tiziano Croatto
  • Dimitra Zarifi
Original Article

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.

Keywords

Post-operative recurrence Crohn’s disease Infliximab Fecal calprotectin 

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Dario Sorrentino
    • 1
    • 10
  • Giovanni Terrosu
    • 2
  • Alberto Paviotti
    • 1
  • Marco Geraci
    • 3
  • Claudio Avellini
    • 4
  • Giorgio Zoli
    • 5
  • Walter Fries
    • 6
  • Silvio Danese
    • 7
  • Pietro Occhipinti
    • 8
  • Tiziano Croatto
    • 9
  • Dimitra Zarifi
    • 1
  1. 1.Department of Clinical and Experimental PathologyUniversity of Udine School of MedicineUdineItaly
  2. 2.Department of Digestive SurgeryUniversity of Udine School of MedicineUdineItaly
  3. 3.MRC Centre of Epidemiology for Child HealthUCL Institute of Child HealthLondonUK
  4. 4.Department of PathologyUniversity of Udine School of MedicineUdineItaly
  5. 5.Department of Internal MedicineSS Annunziata HospitalCento, FerraraItaly
  6. 6.Department of Internal Medicine and Medical TherapyUniversity of MessinaMessinaItaly
  7. 7.Division of GastroenterologyIstituto Clinico Humanitas-RozzanoMilanItaly
  8. 8.Department of Gastroenterology and Digestive EndoscopyBorgomanero—ASL NovaraNovaraItaly
  9. 9.Division of Internal MedicineOspedale di San Vito al TagliamentoSan Vito al TagliamentoPordenone
  10. 10.Cattedra di Gastroenterologia, Pad. Scrosoppi UdineItaly

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