ARI Does Not Appear Prevalent in Patients With Crohn Disease After Ileal Resection

Anastomotic ring inflammation (ARI) does not correlate with endoscopic Crohn disease (CD) disease activity in patients who undergo ileal resection, according to results of a retrospective cohort study presented at the 2019 Advances in Inflammatory Bowel Diseases (AIBD) Meeting. Additionally, the researchers did not identify demographic or phenotypic variables associated with the presence of ARI after ileal resection, suggesting that ARI may not be prevalent among this patient population.

Early inflammation proximal to anastomosis in patients with CD who undergo ileal resection can have a significant impact on prognosis. Some patients also develop inflammatory changes at the level of the anastomotic ring, but the prevalence and significance of these changes is unknown.

To address this, the researchers evaluated data of 91 patients with CD who underwent ileal resection and ileocolonic anastomosis and surveillance colonoscopy within 24 months. All patients were longitudinally followed through up to 4 subsequent colonoscopies, if applicable.

A gastroenterologist reviewed all endoscopy images from all the procedures; the data were graded using the Rutgeerts score (RS) and Simple Endoscopic Score for Crohn Disease (SES-CD).

A total of 20 patients had ARI on the first surveillance colonoscopy—4 patients had complete anastomotic ring, and 16 had partial anastomotic ring. An additional 13 patients developed inflammation at subsequent colonoscopies.

No differences were observed in median RS or SES-CD between the patients who presented with ARI and patients without ARI. Additionally, no association between the presence of ARI and active histologic inflammation in the ileum proximal to anastomosis was found.

Age at the time of surgery was not significantly different between the patients with ARI and the patients without ARI.

The use of postoperative prophylaxis for recurrent CD was not associated with a lower prevalence of ARI.

“Studies looking into the long-term clinical significance of ARI are warranted,” the authors concluded.

—Melinda Stevens

Reference:

Schwartz M, Stein D, Patel PB, Patel A, Otterson M, Yarur A. Prevalence and risk factors for developing anastomotic ring inflammation after ileal resection and ileo-colonic anastomosis in patients with Crohn’s disease [poster 087]. Presented at: 2019 AIBD Meeting; December 12-14, 2019; Orlando, FL. https://www.consultant360.com/meeting-materials/prevalence-and-risk-factors-developing-anastomotic-ring-inflammation-after-ileal. Accessed December 12, 2019.