Post-operative recurrence in Crohn's disease: correlation between the timing of anti-TNF alpha induction after surgery and the Rutgeerts score

Aims Recurrence after surgical intervention for Crohn's disease (CD) poses a significant therapeutic challenge. Although anti-TNF alpha treatments have shown beneficial effects, their timing of induction may play a crucial role in postoperative outcomes. This study aims to analyze the influence of the induction delay of these treatments after surgery on the Rutgeerts score, a key indicator of endoscopic recurrence.

Methods We included 31 patients with Crohn's disease who underwent surgical resection due to complications related to intestinal stenoses. All patients were treated with anti-TNF alpha and underwent endoscopic evaluation based on the Rutgeerts classification. The relationship between the induction delay of anti-TNF alpha after surgery and the Rutgeerts score was analyzed using univariate analysis. The normality and heteroscedasticity of the data were assessed using the Shapiro-Wilk and Levene tests, respectively.

Results The median induction delays of anti-TNF alpha after surgery for the different Rutgeerts scores were as follows: 2.0 months (IQR 2.0) for score i0, 4.0 months (IQR 4.0) for score i1, 6.0 months (IQR 4.75) for score i2, 35.5 months (IQR 29.5) for score i3, and 60.0 months (IQR 36.0) for score i4, with a significant difference noted (p=0.002). Post-hoc analyses with the Dunn-Bonferroni test revealed significant differences between the groups, particularly between i3 and i0 (p=0.001), i3 and i1 (p=0.006), i3 and i2 (p=0.026), as well as i4 and i0 (p=0.002), i4 and i1 (p=0.01), and i4 and i2 (p=0.035). A Pearson correlation analysis was also conducted, revealing a correlation coefficient of 0.703 with a p-value of<0.00001, indicating a strong positive correlation between the induction delay of anti-TNF alpha and the Rutgeerts score. Furthermore, the Spearman analysis showed a coefficient of 0.692 (p=<0.00001), corroborating this significant relationship. Analysis of variance (ANOVA) also confirmed these results, with a p-value of<0.00001.

Conclusions This study highlights the importance of the induction delay of anti-TNF alpha after surgery as a predictive factor for endoscopic recurrence, as measured by the Rutgeerts score. The results indicate a significant correlation between these two variables, suggesting that longer induction delays are associated with an increased risk of recurrence. It is imperative to continue research to refine post-surgical management strategies in Crohn's disease to improve long-term clinical outcomes.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025