Risk factors for postoperative recurrence of Crohn's disease

Postoperative relapse is a common feature of Crohn's disease (CD) in Western countries but its frequency and risk factors have not been studied in the Middle East where there is a rapid upsurge in the incidence of CD. This study aims to research the frequency and risk factors of its recurrence after surgery among 566 Iranian patients with CD in Tehran, Iran.

All 566 patients diagnosed with Crohn's disease that enrolled in Digestive Diseases Research Center (DDRC) Inflammatory Bowel Disease (IBD) from April 1991 until November 2011 were included in our study. We reviewed clinical data that included time of surgery, possible risk factors and follow up after surgery. Multivariate regression analysis was performed to seek possible risk factors for early postoperative recurrence.

The mean age of patients was 30.85 (range: 12-88) years at the onset of enrollment. During a mean follow up of 55 months, 139 (24.5%) out of 566 Crohn's disease patients underwent at least one surgery while 32 (23%) required additional surgery during the period after their first surgical intervention. Cigarette smoking was a risk factor for both initial (p=0.001) and additional surgery (p<0.0001). The penetrating behavior of Crohn's disease, in addition to its effect on surgery (p<0.001), showed a significant influence on disease recurrence (p<0.0007) along with perianal involvement which was significantly associated with relapse (p=0.001). Although disease duration of more than ten years was a significant risk factor for surgery (p=0.043) its effect on recurrence was insignificant (p=0.059).

The rate of initial and additional surgery is much lower in this region of the world, which is partially due to the relatively new occurrence of Crohn's disease in the Middle East. Cigarette smoking, disease duration over ten years, penetrating behavior of CD, and perianal disease were the main risk factors for surgery.