Validating Crohnʼs disease activity indices for use in assessing postoperative recurrence

Walters, T D; Steinhart, A. Hillary; Bernstein, Çharles N.; McKenzie, Marg; Wolff, Bruce G.; McLeod, Robin S.

doi:10.1002/ibd.21524

Cited by 47 publications

(25 citation statements)

References 29 publications

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“…The k coefficient between endoscopic score ±2 and CDAI score ±150 was 0.12 (p = 0.68), indicating poor agreement. Another study published in the same journal thereafter validated the utility of the CDAI in determining the symptomatic disease recurrence in the postoperative setting [34]. They found that recurrence was well predicted by a CDAI of ‡150 (sensitivity 70% and specificity 81%).…”

Section: Crohn's Disease Activity Indexmentioning

confidence: 95%

Management of postoperative Crohn’s disease

Yang

et al. 2014

Expert Review of Gastroenterology & Hepatology

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Surgical treatment does not cure Crohn's disease, and postoperative recurrence is a feature of the clinical course of the disease. Ileocolonoscopy remains the gold standard for the surveillance of recurrent Crohn's disease and should be performed 6-12 months after an operation. Many other non-invasive techniques are also useful and complement endoscopy for the early diagnosis of postoperative recurrence. Anti-TNF agents show great efficacy for the prevention of postoperative recurrence, and long-term use can maintain remission. It remains undetermined whether early treatment after postoperative endoscopic recurrence is ultimately as efficacious as prophylactic therapy.

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Section: Crohn's Disease Activity Indexmentioning

confidence: 95%

Management of postoperative Crohn’s disease

Yang

et al. 2014

Expert Review of Gastroenterology & Hepatology

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“…Currently, whether a patient has clinical POR is best ascertained by combining CDAI with endoscopy findings. 6 A classification of endoscopic POR-that is, the presence of inflammation in the intestinal mucosa-has been proposed by Rutgeerts et al 7 that is widely accepted. The classification consists of a 0-4 point score system that is validated for risk of developing clinical POR (score 0-1, <10% risk at 10 years; score 2, 40% risk at 5 years; score 3-4, 50-100% risk at 5 years).…”

Section: Definitions Diagnosis and Risk Factorsmentioning

confidence: 99%

“…Hence, clinical POR in this study is a composite end point defined by both the CDAI and endoscopic POR. 6 Fistulae and abscesses are also considered end points of disease recurrence. The primary end point of the study is the proportion of patients with clinical and endoscopic recurrence at 76 weeks, whereas the secondary aim is clinical and endoscopic recurrence at week 104, 152 and 208.…”

Section: Unsolved Issuesmentioning

confidence: 99%

State-of-the-art medical prevention of postoperative recurrence of Crohn's disease

Sorrentino

2013

Nat Rev Gastroenterol Hepatol

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Postoperative recurrence of Crohn's disease is a frequent and often severe sequela of the disease. Until a few years ago it was deemed inescapable, as all the conventional medications used to treat the disease have been proven of little benefit in preventing recurrence after surgical treatment. In the past few years, anti-TNF agents given immediately after surgery have shown a remarkable efficacy in the prevention of disease recurrence. Large, randomized, controlled trials are currently underway to confirm these findings. Anti-TNF treatment of endoscopic lesions that occur after surgery seems to be less effective than using TNF antagonists to prevent recurrence. However, although the data are limited, this treatment strategy seems to be still superior to all the other prevention strategies that are not based on anti-TNF agents. Limited data are available on long-term outcomes of patients treated with anti-TNF agents after surgery. They suggest that these medications are safe and effective after many years of treatment. In addition, these agents might prevent recurrence even at doses lower than those used in patients with Crohn's disease who have not had surgery.

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“…10,11 No clinical activity index including Crohn's disease activity index (CDAI) or Harvey-Bradshaw indices has been validated suitably for patients with CD in postoperative setting. [12][13][14] Consequently, the primary endpoint in this study was reoperation indicated for abscess, fistula, perforation, stricture, uncontrolled bleeding, and dysplasia. Perianal procedures, and early laparotomy for complications related to the index surgery (e.g., anastomotic leak, bleeding, evisceration, intra-abdominal abscess), or lysis of adhesions were not considered as reoperation for CD.…”

Section: Biomarker Data and Clinical Follow-upmentioning

confidence: 99%