P185 Natural history of Crohn’s disease postoperative recurrence in a referral centre in the era of biologics and therapeutic intensification based on early endoscopic findings
Bibliographic record
Abstract
We assessed the prevalence and the risk factors of endoscopic and clinical postoperative recurrence (POR) in the era of biologics and therapeutic intensification based on early endoscopic findings in Crohn’s disease (CD). From a prospectively maintained database, we consecutively enrolled all CD patients who underwent intestinal resection and anastomosis between 2011 and 2016 with colonoscopy at 6 months (6m) and follow-up >6 months. Endoscopic POR was defined as Rutgeerts’ Index (RI) ≥i2. Clinical POR was defined as recurrence of symptoms (HBI > 4) leading to hospitalisation or therapeutic intensification after exclusion of other causes of recurrent symptoms. Overall, 316 patients were included (median follow-up 31 months (range 16.0–45.3)): mean CD duration = 11.7 ± 10.8 years, 50.6% female, 11.7% smokers, 22.8% with perianal lesions and 37.6% with prior intestinal resection. The Montreal classification was: L1 = 35.8 %, L2 = 5.7% and L3 = 58.5%, and B1 = 6.3%, B2 = 48.1% and B3 = 45.6%. The rate of endoscopic POR at 6m was 35.8% (i0 = 50.9%, i1 = 13.3%, i2a = 7.0%, i2b = 13.3%, i3 = 8.2%,i4 = 7.3%). In multivariate analysis, >2 anti-TNF prior to surgery (OR = 3.4 [1.2–9.8], p = 0.026), resection length >30 cm (OR = 1.8 [1.1–3.0], p = 0.025) and surgery for refractoriness to medical therapy (OR = 8.6 [1.5–50.5], p = 0.017) were risk factors of endoscopic POR, while female gender (OR = 0.5 [0.3–0.8], p = 0.006), CD duration >10 years (OR = 0.5 [0.3–0.9], p = 0.049) and combination therapy with anti-TNF and immunosuppressive therapies (IS) (OR = 0.4 [0.2–0.8], p = 0.009) decreased this risk. The rate of clinical POR was 9.3% at 1 year and 24.4% at 2 years. In multivariate analysis, prior intestinal resection (HR = 1.6 [1.1–2.4], p = 0.041), >3 biologics before surgery (HR = 2.7 [1.1–6.5], p = 0.031) and RI≥i2 (HR = 2.5 [1.6–3.9], p < 0.0001) were associated with higher risk of clinical POR. Lower risk for clinical POR was found for CD duration >10 years (HR = 0.6 [0.4–0.9], p = 0.037) and post-op combination therapy (anti-TNF + IS) (HR = 0.5 [0.3–0.9], p = 0.028). In patients who did not receive anti-TNF to prevent endoscopic POR and who experienced endoscopic POR (RI ≥ i2) at 6m, starting combination therapy decreased the risk of clinical POR (HR = 0.4 [0.1–0.9], p < 0.05). In our referral centre, the prevalence of endoscopic POR was the lower than historical reporting, suggesting the positive impact of biological therapy. Combination therapy was the most effective approach to prevent and to treat endoscopic POR. This study also provided external validation of the RI (Figure 1). Kaplan Meier curve showing the value of the Rutgeerts’ index to predict clinical postoperative recurrence in Crohn’s disease despite the large use of biologics and a therapeutic intensification based on early endoscopic findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".