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A comparison of the risk of postoperative recurrence between African-American and Caucasian patients with Crohn's disease.

ABSTRACT: BACKGROUND:Many patients with Crohn's disease will develop complications that require surgery. Recurrence after surgery is common. AIM:To assess racial differences in postoperative recurrence between African-Americans and Caucasians. METHODS:Medical records of Crohn's disease patients who underwent surgery (ileal, colonic, or ileocolonic resection) between June 2014 and June 2016 were reviewed. The primary endpoints were clinical and endoscopic remission at 6-12 months after a Crohn's disease surgery. Secondary outcomes included biological and histologic remission. Risks of recurrence were assessed by univariate, multivariate, and propensity score-matched analysis. RESULTS:Thirty-six African-American and 167 Caucasian patients with Crohn's disease were included for analysis. There was no difference in disease location, disease behaviour, type of surgery performed, and pre- or postoperative medication use between the two groups. The rate of endoscopic remission did not differ between African-American and Caucasian patients (50% vs 42%, P = 0.76), and race did not influence the risk of endoscopic recurrence on univariate, multivariate, or propensity score-matched analysis. The rate of clinical remission was significantly lower in African-American patients compared to Caucasian patients (36% vs. 63%, P = 0.008). African-American race was significantly associated with clinical recurrence on univariate (odds ratio (OR) 6.76, 95% CI 1.50-30.40; P = 0.01), multivariate (OR 5.02, 95% CI 1.60-15.80; P = 0.006), and propensity-matched analysis (68% vs. 32% in Caucasians, P = 0.005). Rates of biologic and histologic remission were similar between the two groups on all analyses. CONCLUSIONS:We found that African-American patients with Crohn's disease have a similar degree of objective measures of mucosal inflammation after surgery including endoscopic recurrence as compared to Caucasian patients. However, African-American race was significantly associated with clinical recurrence, suggesting the presence of ethnic variation in postoperative presentation in Crohn's disease.

SUBMITTER: Anyane-Yeboa A

PROVIDER: S-EPMC6669906 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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A comparison of the risk of postoperative recurrence between African-American and Caucasian patients with Crohn's disease.

Anyane-Yeboa Adjoa A Yamada Akihiro A Haider Haider H Wang Yunwei Y Komaki Yuga Y Komaki Fukiko F Pekow Joel J Dalal Sushila S Cohen Russell D RD Cannon Lisa L Umanskiy Konstantin K Smith Radhika R Hurst Roger R Hyman Neil N Rubin David T DT Sakuraba Atsushi A

Alimentary pharmacology & therapeutics 20180820 9

<h4>Background</h4>Many patients with Crohn's disease will develop complications that require surgery. Recurrence after surgery is common.<h4>Aim</h4>To assess racial differences in postoperative recurrence between African-Americans and Caucasians.<h4>Methods</h4>Medical records of Crohn's disease patients who underwent surgery (ileal, colonic, or ileocolonic resection) between June 2014 and June 2016 were reviewed. The primary endpoints were clinical and endoscopic remission at 6-12 months afte ...[more]

PMID: 30126019

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Project description:BackgroundThe modified Rutgeerts' score [RS] differentiates i2a-lesions confined to the anastomosis-and i2b-more than five aphthous ulcers in the neoterminal ileum with normal intervening mucosa, with or without anastomotic lesions-categories. Its relevance for the therapeutic management of Crohn's disease [CD] patients after ileocolic resection is still debated. Our objective was to compare the postoperative recurrence risk in patients with an i2a or i2b score, using an individual patient data meta-analysis.MethodsWe conducted a systematic literature search until July 2020, to identify all relevant studies reporting the i2a/i2b status in the year following ileocolic resection and clinical and/or surgical postoperative CD recurrence in their follow-up. Individual patient-level data were obtained from the corresponding authors. The association between the modified RS and time-to-event was evaluated using a mixed Cox model with the centre as the random effect.ResultsSeven studies published between 2008 and 2019 were included, corresponding to 400 patients: 189 [47%] i2a and 211 [53%] i2b. Median [interquartile range, IQR] time from ileocolic resection to ileocolonoscopy was 6.2 [5.5, 7.9] months and median [IQR] follow-up time after ileocolonoscopy was 4.5 [2.9, 7.3] years. The risk of clinical postoperative recurrence at 1 and 3 years was 11% [6-15%], and 25% [18-32%] in the i2a group versus 9% [5-13%] and 33% [26-41%] in the i2b group [p = 0.63 and p = 0.12, respectively]. No significant difference was observed in terms of time to clinical postoperative recurrence [p = 0.16] or surgical postoperative recurrence [p = 0.87]. Results did not change after excluding patients having initiated an immunosuppressant or a biologic in the 3 months after endoscopy [remaining cohort, n = 361].ConclusionsIn this individual patient data meta-analysis, no difference was observed between i2a and i2b subcategories with regards to clinical or surgical postoperative recurrence. As we wait for prospective trials, the same treatment strategy could be applied to all patients classified as i2 on the Rutgeerts score.

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A comparison of the risk of postoperative recurrence between African-American and Caucasian patients with Crohn's disease.

Publications

A comparison of the risk of postoperative recurrence between African-American and Caucasian patients with Crohn's disease.

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