Early diagnosis and treatment of postoperative endoscopic recurrence of Crohn's disease: partial benefit by infliximab--a pilot study

Dig Dis Sci. 2012 May;57(5):1341-8. doi: 10.1007/s10620-011-2025-z. Epub 2012 Jan 18.


Background: Current data indicate that infliximab-given immediately after surgery-may be very effective in preventing postsurgical recurrence of Crohn's disease. However, it is unknown whether a similar benefit would result from early diagnosis and treatment, rather than prevention of endoscopic recurrence.

Aims: The primary outcome of this study was to clarify whether infliximab, given after diagnosis of postoperative endoscopic recurrence of Crohn's diseases (Rutgeerts score ≥ 2) can induce endoscopic remission (score <2) at 54 weeks. The secondary outcomes were improvement in the endoscopic score and clinical recurrence at 54 weeks.

Methods: In this prospective open label multicenter pilot study 43 patients with ileocolonic Crohn's disease subjected to curative surgery underwent colonoscopy 6 months after surgery. Patients with endoscopic recurrence (Rutgeerts score ≥2) were treated with either mesalamine 800 mg tid or infliximab 5 mg/kg bw on a maintenance basis. Colonoscopy was performed after 54 weeks of therapy.

Results: A total of 24/43 patients were diagnosed with endoscopic recurrence at 6 months. Thirteen were treated with infliximab and 11 with mesalamine. None of the 11 mesalamine-treated patients had endoscopic remission at 54 weeks. Two had clinical recurrence at 8 and 9 months. Fifty-four percent of patients treated with infliximab had endoscopic remission at 54 weeks (P = 0.01) while 69% had an improvement in the endoscopic score. None had clinical recurrence.

Conclusions: Treatment of postsurgical endoscopic lesions by infliximab appears superior to mesalamine. However, a sizeable proportion of patients did not fully benefit from this strategy.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Antibodies, Monoclonal / administration & dosage*
  • Chemoprevention / methods
  • Colonoscopy / adverse effects*
  • Colonoscopy / methods
  • Crohn Disease / diagnosis
  • Crohn Disease / physiopathology
  • Crohn Disease / therapy*
  • Early Diagnosis
  • Female
  • Follow-Up Studies
  • Humans
  • Infliximab
  • Male
  • Mesalamine / administration & dosage*
  • Middle Aged
  • Pilot Projects
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / prevention & control
  • Postoperative Period
  • Secondary Prevention
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal
  • Antibodies, Monoclonal
  • Mesalamine
  • Infliximab