Aims: Bowel resection for Crohn’s disease is frequently followed by relapse or further surgery. The aims of this study are to assess whether the inflammatory activity in the resection specimen or the type of resection may predict relapse or further surgery in children.
Patients and methods: Twenty nine children, 13 girls, mean age 14 had resection by one surgeon. Inflammatory activity in the specimen was scored by a pathologist blinded to patient outcome using the following histological features: stricturing, mucosal or submucosal fibrosis, pyloric metaplasia, active inflammation at resection margins, granulomas, and perivascular granulomas, deriving an activity index. Following resection, any immunosuppressive therapy, other than azathioprine, or further surgery, was taken to indicate relapse and time to relapse recorded. Left colonic resections were compared to all other resections. The effect of activity index on time to relapse or further surgery was assessed using a Cox proportional hazard method. Left colon resections were compared with all other resections using Kaplan Meier survival curves/ log rank test.
Results: The activity index was not a significant predictor of the time to relapse, χ2 = .3, p = .56, or further surgery, χ2 = .13, p = .71. Children undergoing left colonic resection were significantly more likely to relapse and require medical therapy χ2 = 4.4, p = 0.03 or further surgery χ2 = 7, p = 0.008. Children were 4 times more likely to relapse and 6 times more likely to have further surgery after left colon resection than any other resection.
Conclusions: Following resection in childhood Crohn’s disease, the probability of relapse/further surgery is dependent on disease location not inflammatory severity. Better therapy is needed for distal Crohn’s colitis.
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