Issue 07

Clinical Question

How many patients with Crohn’s disease (CD) who have an intestinal resection require a second resection within 10 years?

Editor’s Bottom Line

The rate of a second intestinal resection in CD patients is approximately 35%. This rate has been decreasing since the 1980’s.

Editorial Note

Data from the University of Alberta (Ma et al, submitted CGH) identifies that anti-TNF therapy within 2 years of CD diagnosis markedly reduces intestinal resection rates; implying early control of inflammation improves patient outcomes.

Reference

Frolkis AD, Lipton DS, Fiest KM, et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol. 2014 Nov;109(11):1739–48.  https://www.ncbi.nlm.nih.gov/pubmed/25331349

Synopsis

A systematic literature search in three databases retrieved a total of 12 population-based studies investigating the incidence of second intestinal resections for the treatment of CD. The timespan of the studies ranged from 1955 through to 2009; two studies reported incidence for pediatric CD.

The overall risk for a second intestinal resection in patients with CD was 28.7% based upon 8 studies. Pooling results from 6 studies, the 5-year risk for second resection was 24.2% and the 10-year risk for a second resection was 35.0%. Pre-1980 studies reported that ~50% of patients with CD had a second intestinal resection within 10 years. Studies conducted after 1980 reported that less than one third of patients required a second resection within 10 years.

Details

Study Design: Meta-analysis
Funding: Alberta IBD Consortium
Allocation: n/a
Setting: n/a
Level of Evidence: 2a (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.