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Addition of mesalazine for subclinical post-surgical endoscopic recurrence of Crohn's disease despite preventive thiopurine therapy: A case-control study
- Source :
- Journal of Gastroenterology and Hepatology. 29:1413-1417
- Publication Year :
- 2014
- Publisher :
- Wiley, 2014.
-
Abstract
- Background and Aim Thiopurines prevent Crohn's disease (CD) endoscopic recurrence (ER) at least in 50% of patients 1 year after surgery. This study aimed to evaluate the value of adding mesalazine in patients with subclinical ER despite preventive thiopurine therapy. Methods Crohn's disease patients with ileocecal resection treated with thiopurines for postsurgical recurrence prevention in whom mesalazine was added (cases) to treat ER without clinical recurrence (CR) were identified and compared with those in whom no treatment was added to thiopurines (controls). All patients were followed up for at least 1 year from the index endoscopy. Development of CR as well as evolution of mucosal lesions was evaluated. Results Thirty-seven patients were included (19 cases and 18 controls). Initial Rutgeerts' score was i2 in 16 patients (9 cases and 7 controls), and i3 in 21 patients (10 cases and 11 controls). After a median clinical follow-up of 59 months (interquartile range 22–100) from the index endoscopy, six cases (32%) and two controls (11%) developed CR (P = 0.2). After a median time to last endoscopic follow-up of 23 months (interquartile range 17–71), 18 patients (49%) showed improvement in Rutgeerts' score, 11 patients (30%) demonstrated progression of mucosal lesions, and 8 (22%) had no changes, with no differences between study groups. Conclusions The addition of mesalazine seems to be of no benefit in patients with subclinical endoscopic recurrence while on thiopurine prevention. Moderate endoscopic postsurgical recurrence while on thiopurines may even revert with no additional therapy in some patients.
- Subjects :
- medicine.medical_specialty
Crohn's disease
Hepatology
Thiopurine methyltransferase
biology
medicine.diagnostic_test
business.industry
Gastroenterology
Case-control study
Disease
medicine.disease
Surgery
Endoscopy
chemistry.chemical_compound
Mesalazine
chemistry
Interquartile range
Internal medicine
biology.protein
Medicine
business
Subclinical infection
Subjects
Details
- ISSN :
- 08159319
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Journal of Gastroenterology and Hepatology
- Accession number :
- edsair.doi...........e2516819ee744fb42c12b05321c46858
- Full Text :
- https://doi.org/10.1111/jgh.12579