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The following is a summary of “Prognostic Value of the Modified Rutgeerts Score for Long-Term Outcomes After Primary Ileocecal Resection in Crohn’s Disease,” published in the February 2024 issue of Gastroenterology by Bak, et al.
Understanding the prognostic implications of the modified Rutgeerts score (mRS) in Crohn’s disease (CD) patients is crucial. For a study, researchers sought to assess the prognostic value of the mRS for long-term outcomes following primary ileocecal resection in CD patients.
The retrospective study included CD patients who underwent primary ileocecal resection and had an available mRS at the first postoperative ileocolonoscopy (index mRS). The primary outcome was surgical recurrence, while secondary outcomes included clinical recurrence and progression to severe endoscopic recurrence (≥i3). Cox proportional hazard models assessed the association between index mRS and outcomes.
652 patients were included, with a mean follow-up of 6.4 years. Surgical recurrence rates increased with higher index mRS (i0: 7.7%, i1: 5.3%, i2a: 12.9%, i2b: 19.1%, i3: 28.8%, i4: 47.8%). Similarly, clinical recurrence rates escalated with increasing index mRS (i0: 42.2%, i1: 53.7%, i2a: 58.5%, i2b: 80.2%, i3: 79.4%, i4: 95.3%). Progression to severe endoscopic recurrence also increased with higher index mRS. Cox regression analysis revealed that index mRS ≥ i2b was associated with surgical recurrence (adjusted hazard ratio [aHR] 3.0; 95% CI 1.5–5.6), while index mRS ≥ i1 was associated with clinical recurrence (aHR 1.7; 95% CI 1.2–2.4). Moreover, an index mRS of i1 (aHR 2.0; 95% CI 1.1–3.7) or i2b (aHR 2.5; 95% CI 1.4–4.6) was associated with progression to severe endoscopic recurrence.
The mRS correlated closely with the risk of surgical and clinical recurrence in CD patients post-primary ileocecal resection. An index mRS ≥ i2b indicates a higher risk of surgical recurrence, while an index mRS ≥ i1 signifies a higher likelihood of clinical recurrence. Similarly, i1 or i2b index mRS is associated with progression to severe endoscopic recurrence. The findings supported the importance of closely monitoring disease activity and optimizing treatment strategies, especially in patients with ileal lesions, while considering a more conservative approach in patients with anastomotic lesions.