Crohn's strictures, strictureplasties predict obstruction recurrence

Last Updated: 2009-07-23 17:32:27 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In Crohn's disease patients who undergo surgery for strictures, the number of strictures and strictureplasties may predict the likelihood of recurrent obstruction, according to researchers at the Mount Sinai Medical Center in New York City.

Dr. Adrian J. Greenstein and colleagues reviewed data on 88 patients with 339 strictureplasties corrected between 1984 and 2004, using reoperation as a marker for recurrence.

According to their report in the July issue of the Journal of the American College of Surgeons, 5-year actuarial reoperation rates were 14% in patients with no more than eight strictures versus 31% in patients with more than eight (p=0.01).

When patients were categorized by number of strictureplasties, those with no more than four had a 5-year actuarial reoperation rate of 14%, whereas patients who required more than four strictureplasties had an actuarial reoperation rate of 33% (p<0.01).

On multivariate analyses, both strictures and strictureplasties were independently associated with recurrence, with recurrence risk increasing by 7% for each stricture and by 23% for each additional strictureplasty, the authors report.

"To our knowledge, this is the first study to demonstrate a significant relationship been number of strictures and number of strictureplasties and recurrence in Crohn's disease," the investigators write. Their observations are most likely due to disease-related factors, they believe.

"The presence of more strictures, alone, does not lead to an increase in recurrence, but is most probably a marker of more advanced or more aggressive disease," the investigators point out, adding that more work is necessary "to better understand the reasons for these associations, and to identify potential interventions to reduce recurrence."

J Am Coll Surg 2009;208:1065-1070.