Endoscopic Recurrence in Crohn’s: Post-Ileostomy Predictors

TOPLINE:

Endoscopic recurrence was observed in one third of patients with Crohn’s disease (CD) within 5 years of ileostomy placement, with ileal involvement and prior exposure to biologic therapy being identified as predictive factors.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess en­doscopic ileal recurrence after long-term ileostomy crea­tion and to identify possible risk factors.
• They identified 150 patients (median age at diagnosis, 22 years; 64% women) with CD and long-term ileostomy at a tertiary referral hospital in Amsterdam from 1988 to August 2023.
• Long-term ileostomy was defined as the presence of ileostomy for a minimum of 12 months.
• The primary outcome was the occurrence of ileitis proximal to ileostomy, determined by the presence of aphthous lesions and/or ulcerations during endoscopy, assessed using an ulcer subscore ≥ 1 in the Simple Endoscopic Score for CD.

TAKEAWAY:

• Overall, 116 patients (77.3%) underwent endoscopic assessment over a median follow-up duration of 6 years, with endoscopic recurrence being reported in 46 patients.
• Endoscopic recurrence rates were 11.2%, 27.3%, and 33.0% at 1, 3, and 5 years, respectively, with a median time to the detection of ileitis of 147.7 months.
• Ileal involvement (hazard ratio [HR], 1.99; P = .02) and prior exposure to biologic therapy (HR, 2.48; P = .01) were identified as independent predictors of endoscopic recurrence.
• Median faecal calprotectin levels were lower among patients in endoscopic remission than among those with active disease (P < .001), with those with large ulcers (≥ 0.5 cm) having higher median levels than those with only aphthous lesions (P = .034).

IN PRACTICE:

“Due to its excellent discriminatory ability, we suggest meas­uring fecal calprotectin in ileostomy effluent every 6 months postoperatively to guide the need for and frequency of endo­scopic assessments,” the authors of the study wrote.

SOURCE:

This study was led by Lotte Oldenburg, MD, and Brecht Hens, MD, Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands. It was published online on July 12, 2025, in Inflammatory Bowel Diseases.

LIMITATIONS:

This study was retrospective in nature, making the results hypothesis generating. The lack of official guidance on managing patients with ileostomy could have led to variations in the timing of endoscopy and treatment decisions. Using a selective approach to endoscopy may have introduced bias, which could have resulted in an overestimation of the actual rate of endoscopic recurrence.

DISCLOSURES:

No funding was received for this study. One author reported receiving speakers bureau fees and serving as a consultant for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.