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POST OPERATIVE RECURRENCE OF CROHN’S DISEASE AFTER COLONIC RESECTION: RESULTS FROM THE RESECOL STUDY BY GETECCU

Jose Luis Rueda García 1, Cristina Suárez Ferrer 1, CORAL RIVAS 2, Irene García de la filia Molina 3, Agnès Fernández-Clotet 4, Elena Céspedes Martínez 5, Cristina Martinez Cuevas 6, Domingo Cesar Balderramo Barboza 7, Lara Arias García 8, Helena Martinez Lozano 9, Margalida Calafat Sard 10, Daniel Martin Rodriguez 11, Jose Xavier Segarra Ortega 12, Javier P. Gisbert 13, Eduard Brunet 14, Irene Gonzalez Partida 15, Elena Cerrillo Bataller 16, Pilar Varela Trastoy 17, Katherine Auquilla Pauta 18, Laura Igualada 19, Miquel Marquès-Camí 20, Carmen Muñoz Villafranca 21, Ruth María de Francisco García 22, Alfonso Elosua 23, Iria Bastón-Rey 24, Jesús Martínez-Cadilla 25, Laura Pardeiro Mariño 26, Olivia Belen Galipienso 27, Pablo Vázquez García 28, Miriam Latre Escudero 29, Pau Sendra Rumbeu 30, Eva maria Sierra Moros 31, Ángel Ponferrada-Díaz 32, María Rosario Arribas López 33, Silvia Rodríguez-Sánchez 34, Pablo Miles Wolfe García 35, Maria Angeles Ruiz-Ramirez 36, Oscar Moralejo Lozano 37, Ariadna Altadill 38, María Carmen López-Martín 39, Patricia Sanz 40, Luis Madrigal Bayonas 41, Jose Maria Huguet 42, Gisela Torres 43, Inmaculada Alonso Abreu 44, María Dolores Martín-Arranz 1, Miriam Mañosa Ciria 45, Yamile Zabana 46

Affiliations

1 Hospital Universitario La Paz, Madrid, Spain|||La Paz Institute for Health Research (IdiPAZ), Madrid, Spain

2 Hospital Universitario Marqués de Valdecilla, Santander, Spain

3 Hospital Ramon y Cajal, Madrid, Spain

4 Hospital Clinic, Barcelona, Spain

5 Hospital Universitario Vall d'Hebron, Barcelona, Spain

6 Hospital Río Hortega, Valladolid, Spain

7 Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina

8 Hospital Universitario de Burgos, Burgos, Spain

9 Hospital Universitario Gregorio Marañon, Madrid, Spain

10 Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

11 Hospital Infanta Cristina, Madrid, Spain

12 Hospital Universitario de Salamanca, Salamanca, Spain

13 Hospital Universitario La Princesa, Madrid, Spain|||Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid,

14 Parc Tauli, Sabadell, Spain

15 Puerta de Hierro Hospital, Madrid, Spain

16 Hospital La Fe, Valencia, Spain

17 Hospital Universitario de Cabueñes, Gijón, Spain

18 Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain

19 Hospital Universitario Fundación Alcorcón, Alcorcón, Spain

20 Hospital Universitari Arnau de Vilanova, Lleida, Spain

21 Hospital Universitario de Basurto, Bilbao, Spain

22 Hospital Universitario Central de Asturias, Madrid, Spain

23 Hospital Universitario de Navarra, Pamplona, Spain

24 University Hospital of Santiago de Compostela, La Coruña, Spain

25 Hospital Álvaro Cunqueiro, Vigo, Spain

26 Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain

27 Hospital General Universitario Dr. Balmis, Alicante, Spain

28 Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain

29 Hospital Universitario San Jorge de Huesca, Huesca, Spain

30 Hospital Universitario Son Espases, Mallorca, Spain

31 Hospital Universitario Miguel Servet, Zaragoza, Spain

32 Hospital Infanta Leonor, Madrid, Spain

33 Hospital Infanta Sofía, Madrid, Spain

34 Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain

35 Hospital Sierrallana, Torrelavega, Spain

36 Hospital General de Almansa, Albacete, Spain

37 Complejo Hospitalario de Toledo, Madrid, Spain

38 Consorci Sanitari de Terrassa (CST), Terrassa, Spain

39 Hospital Universitario Infanta Elena, Madrid, Spain|||Instituto de Investigación Sanitaria Fundación Jiménez Diaz, Madrid, Spain

40 Hospital Royo Villanova, Zaragoza, Spain

41 Hospital General Universitario Rafael Méndez, Lorca, Spain

42 Hospital General de Valencia, Valencia, Spain

43 Hospital General de Granollers, Barcelona, Spain

44 University Hospital of Canary Islands, Gran Canaria, Spain

45 Hospital Universitari Germans Trias i Pujol, Badalona, Spain

46 Hospital Universitari Mútua Terrassa, Terrassa, Spain|||Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

Summary

AI Generated

In this Spanish retrospective study of 224 Crohn's disease patients who underwent colectomy, postoperative recurrence rates were significantly higher after subtotal colectomy compared to segmental colectomy despite similar prophylactic therapy.

Clinical postoperative recurrence occurred in 63% of subtotal colectomy patients versus 38% of segmental colectomy patients, and endoscopic recurrence occurred in 71% versus 50% respectively, both statistically significant differences.
Subtotal colectomy, smoking, and myenteric plexitis were independently associated with both clinical and endoscopic postoperative recurrence in multivariate analysis, with subtotal colectomy showing hazard ratios of 2.36 and 2.47 respectively.
Surgical recurrence requiring reoperation occurred at similar rates in both groups at approximately 11-12% during a median follow-up of 19.5 months.
Among patients with endoscopic recurrence, 70% also developed clinical recurrence, demonstrating substantial overlap between endoscopic and symptomatic disease.
The authors conclude their data support favoring segmental resection when feasible, though they note prospective research is needed.

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Abstract

Introduction

Features and management of post operative recurrence (POR) of Crohn’s Disease (CD) after ileocecal resection (ICR) are well defined, but POR after colectomy is scarcely described.

Aims & Methods

Multicenter, nationwide, retrospective study promoted by the Spanish Working Group on Crohn's and Colitis (GETECCU). CD patients who underwent segmental colectomy (SC) or subtotal colectomy (STC) between 2012 and 2023 were included. Primary endpoint was clinical POR, defined as CD-related symptoms requiring salvage therapy despite POR prophylaxis. Secondary endpoints included endoscopic POR (anastomotic and/or perianastomotic CD-associated lesions at endoscopy), association between clinical and endoscopic POR, comparison of clinical and endoscopic POR-free survival among different types of colectomy, surgical recurrence (need for reoperation) depending on colectomy subtypes; and identification of factors associated with post-colectomy POR.

Results

224 patients were included: 157 (70%) underwent SC and 67 (30%) underwent STC. In the SC group, patients were older [44 (SD 15) vs 39 (SD 14) years old, p=0.01] and B3 phenotype was more frequent [68/157 (43%) vs 14/67 (21%), p = 0.003]. POR prophylaxis was prescribed in 119/157 (76%) SC patients and in 47/67 (70%) STC patients, with no significant differences regarding the choice of agent (main baseline characteristics of the study population are described in Table 1). The main indication for surgery was stenosing disease [both in SC group (83/157, 53%) and STC group (34/67, (51%)]. Median follow-up was 19.5 [3.7–67.9] months to clinical POR and 14.0 [5.9–54.1] months to endoscopic POR. Clinical POR developed in 60/157 (38%) in the SC group and 42/67 (63%) in the STC group (p = 0.001). Endoscopic evaluation was available in 190/224 patients (85%) [131/157 SC (83%) and 59/67 (88%) STC]; endoscopic POR was detected in 66/131 (50%) SC patients and 42/59 (71%) STC patients (p=0.012). Among patients with endoscopic POR, 76/108 (70%) also presented clinical POR: 43/66 (65%) patients in the SC group and 33/42 (79%) in the STC group (p=0.203). Clinical and endoscopic POR-free survival was higher for SC than for STC (p log-rank <0.05). Surgical recurrence occurred in 17/157 patients (11%) in the SC group and in 8/67 patients (12%) in the STC group (p=0.992). Multivariate stepwise Cox proportional hazards regression showed significant association of STC, smoking and myenteric plexitis with both clinical POR (HR 2.36, 95%CI [1.45 - 3.82]; HR 1.34, 95%CI [1.03 - 1,75] and HR 1.71, 95%CI [1.01 - 2.91] respectively) and endoscopic POR (HR 2.47, 95%CI [1.49 - 4.10], HR 1.36, 95%CI [1.03 - 1.79] and HR 1.83, 95% CI [1.01 - 3.29], respectively); and immunomodulator prophylaxis with endoscopic POR (HR 1.72, 95%CI [1.02 - 2.90]) (all p-values <.05).

Variable	Segmental colectomy¹ (n=157)	Subtotal colectomy¹ (n=67)	p-value²
Age	44.1 (SD 15.2)	39.2 (SD 14.2)	0.01
Sex	Male: 71 (45%), Female: 86 (55%)	Male: 37 (55%), Female: 30 (45%)	0.2
CD phenotype (Montreal)	B1: 26 (17%), B2: 63 (40%), B3: 68 (43%)	B1: 20 (30%), B2: 33 (49%), B3: 14 (21%)	0.003
Previous surgery	None: 125 (86%), ICR: 11 (7%), EUA³: 5 (3.2%), other: 6 (3.8%)	None: 56 (84%), ICR: 5 (7.5%), EUA: 2 (3%), other: 4 (6%)	>0.9
Prior advanced therapy failure (biologics and/or JAK inhibitors)	1: 113 (72%), 2: 22 (14%), 3: 14 (8.9%), 4: 4 (2.5%), 5: 3 (1.9%), 6: 1 (0.6%)	1: 44 (66%), 2: 13 (19%), 3: 2 (3%), 4: 5 (7.5%), 5: 2 (3%), 6: 0 (0%), 7: 1 (1.5%)	0.12
Prior immunomodulator (IMM) failure	Yes: 56 (36%), No: 101 (64%) Monotherapy: 10 (1.75%)	Yes: 23 (34%), No: 43 (66%) Monotherapy: 3 (4.5%)	0.8
POR prophylaxis (biologics and/or JAK inhibitors)	Infliximab: 21 (13.4%), Adalimumab: 27 (17.2%), Certolizumab: 2 (1.3%), Ustekinumab: 7 (4.4%), Vedolizumab: 4 (2.54%)	Infliximab: 12 (17.9%), Adalimumab: 6 (8.9%), Ustekinumab: 4 (6%), Vedolizumab: 1 (1.5%), Upadacitinib: 1 (1.5%)	0.4
POR prophylaxis with added IMM (combotherapy)	Yes: 61 (39%), No: 96	Yes: 23 (34%), No: 44 (66%)	0.5
Table 1: Summary of the main characteristics of the study population. ¹mean (SD), n(%); ² Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test ³Exploration Under Anesthesia

Conclusion

POR remains common after colectomy in patients with CD. Clinical and endoscopic POR rates are higher following STC compared to SC in patients under similar prophylactic regimes. Although prospective research is still warranted, our data support favoring segmental resection of colonic CD when feasible.

Disclosure

J.L.R.G. has received financial support for traveling and educational activities or has received fees as a speaker from Abbvie, Kern Pharma, Janssen, Takeda, Pfizer, Lilly, Galapagos, Adacyte, Ferring, Tillotts Pharma, Faes Farma, Norgine and Casen. C.S.F. has received financial support for traveling and educational activities or has received fees as a speaker or consultant from Abbvie, Kern Pharma, Lilly, Ferring, MSD, Janssen, Takeda and Tillotts Pharma. YZ has received financial support for travelling and educational activities from or has served as an advisory board member for AbbVie, Adacyte, Alfasigma, Almirall, Amgen, Boehringer Ingelheim, Dr Falk Pharma, Faes Pharma, Fresenius Kabi, Ferring, Galapagos, Janssen, Johnson&Johnson, Kern, Lilly, MSD, Otsuka, Pfizer, Sanofi, Shire, Takeda, and Tillotts Pharma. The rest of the authors have no conflicts of interest to declare regarding this study.

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Predicting outcomes in IBD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

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GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

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GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Leticia Rodríguez-Alcolado 1, Marcos Navares-Gómez 2, Sergio Casabona-Francés 3, Javier Molina-Infante 4, Danila Guagnozzi 5, Paula Soria-Chacartegui 2, Sara Feo Ortega 6, Laura Arias-González 7, Macarena Torres-Larrubia 8, Ronald Llerena Castro 5, Verónica Martín Domínguez 3, Jose Zamorano 8, Francisca Molina-Jiménez 3, Pedro L Majano 9, Jennifer Fernández-Pacheco 3, Dolores Rivas 8, Elena Grueso-Navarro 7, Pablo Zubiaur 2, Francisco Abad-Santos 10, Cecilio Santander Vaquero 11, Alfredo J. Lucendo 12, Emilio Jose Laserna-Mendieta 7

Affiliations

1 Hospital General de Tomelloso, Gastroenterology Research Unit / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain|||Universidad de Alcalá, Alcalá de Henares (Madrid), Spain

2 Hospital Universitario de La Princesa, Clinical Pharmacology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain

3 Hospital Universitario de La Princesa, Gastroenterology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain

4 Hospital San Pedro de Alcantara, Caceres, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

5 Hospital Universitario Vall d'Hebron, Barcelona, Spain

6 Hospital General de Tomelloso, Pediatrics / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain

7 Hospital General de Tomelloso, Gastroenterology Research Unit / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

8 Hospital San Pedro de Alcantara, Caceres, Spain

9 Hospital Universitario de La Princesa, Gastroenterology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain|||Universidad Complutense de Madrid, Madrid, Spain

10 Hospital Universitario de La Princesa, Clinical Pharmacology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

11 Hospital Universitario de La Princesa, Gastroenterology / Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain|||Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain

12 Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain|||Hospital General de Tomelloso, Gastroenterology / Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM), Tomelloso, Spain

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Abstract

Introduction

Genetic variants associated to a higher risk of developing eosinophilic esophagitis (EoE) and other atopic conditions have been described. However, no study has investigated how these genetic variants influence clinical features of EoE or the atopic concomitances that usually accompanied this disease.

Aims & Methods

This study aims to assess whether single nucleotide polymorphisms (SNPs) in genes related to EoE and atopies associate with disease features and atopic concomitances in a large, representative cohort. Patients diagnosed of EoE according to clinical guidelines were recruited from 4 Spanish referral hospitals and demographical and clinical data were obtained both retrospectively and prospectively. The concomitant atopies analyzed were rhinitis, conjunctivitis, asthma, dermatitis and any food allergy. The recruited cohort was randomly divided into discovery (DC) and validation cohorts (VC) (70% and 30%, respectively). Genotyping was performed using an Open Array platform with 60 SNPs on DNA obtained from peripheral blood. Chi-square or Fisher’s exact test were used for statistical comparisons.

Results

Overall, 647 patients (74.7% male, 32.4±15.2 mean age) were included; 81% of them with an inflammatory phenotype. Rhinitis was the most common atopy (55.8%), while dermatitis was the least frequent (17.5%). Food allergy was documented in 28% of patients.
In relation to EoE characteristics, four SNPs were initially associated with endoscopic findings (measured by EREFS score) and with peak eosinophil counts in esophageal biopsies within the discovery cohort. However, only rs77569859 in the CAPN14 gene remained statistically significant in the validation cohort. TC and CC genotypes of this variant, present in 23.7% of the cohort, were associated with lower EREFS score under a dominant model (3.30±1.60 vs 2.92±1.66, p=0.011 DC/0.002 VC). Additionally, rs76562819, also in CAPN14 gene, showed a trend toward a lower peak eosinophil count per high power field (47.7±24.4 vs 66.6±48.3, p=0.005 DC/0.116VC) under a recessive model (AG and GG genotypes in 11.3% of our patients).
Regarding atopic comorbidities, rs1800925-TT in IL13 (found in 5.7% of our patients) was associated a higher prevalence of conjunctivitis (60% vs 39% in the overall cohort, p=0.020 DC/0.057 VC) and showed a trend toward increased asthma prevalence (54% vs 35%, p=0.056 DC/0.155 VC). A weaker association with asthma was observed for STAT6 rs324015, with an increased prevalence in patients with AG and GG genotypes (41% vs 32%, p=0.079 DC/0.162 VC; present in 34.9 % of the cohort). For dermatitis, a protective effect was seen in patients with the TT genotype of rs2032582 in ABCB1 gene (found in 16.1% of our patients), as the prevalence decreased from 19% to 8% (p=0.033 DC/0.157 VC). No consistent associations were found for rhinitis or food allergy with any SNP across both cohorts.

Conclusion

We have identified significant associations between genetic variants and both clinical features and atopic comorbidities in Spanish patients with EoE, highlighting the potential of genetic profiling to improve clinical characterization and patient management.

Event

UEG Week Berlin 2025

Topics

Histopathology Mechanisms & Personalised Medicine Oesophagus

Submission format

Abstract

Session

EoE: From gene to clinic

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

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Ulrike von Arnim

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Ian White

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Therapy update EoE: Conventional treatment and treatment options for children

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Therapy update EoE: Conventional treatment and treatment options for children

Jorge Amil Dias 1, Ulrike von Arnim 2

Affiliations

1 Hospital Lusíadas, Porto - Paed. Gastroenterology, Porto, Portugal

2 Otto-Von Guericke University, Madgeburg, Germany

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Abstract

Event

UEG Week Berlin 2025

Session

Therapy update: EoE

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

Therapy update EoE: Conventional treatment and treatment options for children

Ulrike von Arnim

How to fight fake news in medicine?

Wendi LeBrett

LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

Ian White

EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

Elisa Marabotto

ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

Knut E.A. Lundin

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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How to fight fake news in medicine?

Wendi LeBrett 1

Affiliations

1 David Geffen School of Medicine, Los Angeles, United States of America

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Abstract

Event

UEG Week Berlin 2025

Topics

Immunology

Session

Opening Plenary

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

Therapy update EoE: Conventional treatment and treatment options for children

Ulrike von Arnim

How to fight fake news in medicine?

Wendi LeBrett

LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

Ian White

EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

Elisa Marabotto

ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

Knut E.A. Lundin

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

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LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

Maya Fischman 1, Michal Codish 2, Revital Barkan 3, Ian White 4, Nir Wasserberg 4, Keren M Rabinowitz 5, Tom Konikoff 5, Irit Avni-Biron 5, Hagar Banai Eran 5, Yifat Snir 5, Henit Yanai 3, Lihi Godny 4, Iris Dotan 4, Jacob E. Ollech 4

Affiliations

1 Rabin Medical Center, Petah Tikva, Israel|||Hebrew University of Jerusalem, Jerusalem, Israel

2 Tel Aviv University, Tel Aviv, Israel

3 Rabin Medical Center, Petah Tikva, Israel|||Tel Aviv University, Tel Aviv, Israel

4 Tel Aviv University, Tel Aviv, Israel|||Rabin Medical Center, Petah Tikva, Israel

5 Rabin Medical Center, Petah Tikva, Israel

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Abstract

Introduction

In patients with ulcerative colitis (UC), total proctocolectomy with restorative ileal pouch-anal anastomosis (IPAA) is a definitive surgical treatment for refractory disease or colorectal dysplasia. A short rectal cuff is typically retained and anastomosed to the pouch, and may become inflamed over time, a condition referred to as cuffitis. The clinical relevance of cuffitis remain unexplored. In this study, we aimed to characterize the long-term disease course associated with histologic cuffitis.

Aims & Methods

Patients with UC who underwent total proctocolectomy and IPAA were prospectively followed in a comprehensive pouch clinic at a tertiary referral center for patients with inflammatory bowel diseases (IBD). We included all patients who underwent at least one pouch endoscopy with paired pouch and cuff biopsies between 2017 and 2024. Cuffitis was defined as a NANCY Index histologic score of 3-4, and pouchitis was defined as histologic subscore of PDAI³2. Outcomes assessed included documented inflammatory pouch flares, defined by clinical evaluation; antibiotics used due to pouch inflammation; and initiation of biologics. Associations were evaluated using Poisson regression to estimate incidence rate ratios (IRRs) and Fisher’s exact test for categorical comparisons.

Results

A total of 116 patients underwent 250 pouch endoscopies during the study period. Average age of the cohort was 50.4 (±14.9) and 59% were females. Histologic pouchitis was detected in 80 (68.9%), and cuffitis in 76 (65.5%) patients. Most patients had extensive disease prior to IPAA (n=105, 90.5%) and indication for surgery was refractory UC (n=94, 81.0%). Concurrent pouchitis and cuffitis were identified in 54 (46.5%) patients. Patients with histologic-proven cuffitis had a significantly higher incidence rate of subsequent disease flares(IRR 4.39, 95% CI: 2.26-9.86, p<0.001) and required more antibiotic courses (IRR 1.94, 95% CI: 1.11-3.62, p=0.027) compared to those who never developed cuffitis. These associations remained significant after adjusting for the presence of histologic pouchitis. No significant difference was observed in the initiation of biologics (p=0.81). Among patients with at least two endoscopies during follow-up and isolated cuffitis at baseline (n=61), 6 patients with isolated cuffitis further developed new-onset pouchitis, while 15 patients with isolated pouchitis subsequently developed cuffitis. The remaining 40 patients (65.5%) maintained the same inflammatory pattern over time.

Conclusion

Histologic-proven cuffitis is independently associated with adverse long-term outcomes in patients post-IPAA, including flares and repeated antibiotic use, even in the absence of pouchitis. The persistence of inflammation in the retained rectal cuff, representing a remnant of the previously diseased colonic mucosa, raises mechanistic questions about its potential role in modulating inflammatory activity of the pouch. These findings emphasize the clinical importance of evaluating the rectal cuff in patients post-IPAA. Routine histologic assessment of the cuff should be incorporated into post IPAA surveillance, and interventional studies are warranted to determine whether targeted treatment of cuffitis can mitigate pouch related morbidity.

Disclosure

Jacob E Ollech: Has received grant support from Pfizer, consulting fees from Takeda, and
speaker fees from Abbvie, Janssen, Pfizer, Takeda, Novartis, and Bristol Myers Squibb.
Iris Dotan: consultation fee or honorarium from: Abbott, Abbvie, Athos, Arena, Altman
Research, Cambridge Healthcare, Celltrion, Celgene/BMS, Eli-Lilly, Ferring, Falk Pharma, Food
Industries Organization, Gilead, Galapagos, Iterative Scopes, Integra Holdings, Janssen,
Neopharm, Pfizer, Rafa laboratories, Roche/Genentech, Sangamo, Sublimity, Sandoz, Takeda,
Wildbio. Grants: Altman Research, BMS, Pfizer

Event

UEG Week Berlin 2025

Topics

Colorectal Endoscopy Surgery IBD

Submission format

Abstract

Session

Lower GI: Surgical considerations

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

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Ulrike von Arnim

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Wendi LeBrett

LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

Ian White

EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

Elisa Marabotto

ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

Knut E.A. Lundin

UEG Presentation

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EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

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EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

Francesco Calabrese 1, ANDREA PASTA 1, Graziana Santamorena 1, Elisa Marabotto 1, Manuele Furnari 1, Edoardo G. Giannini 1, Giorgia Bodini 1

Affiliations

1 Università Degli Studi Di Genova/irccs Policlinico San Martino, Genova, Italy

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Abstract

Introduction

Ulcerative colitis (UC) is a chronic inflammatory bowel disease where accurate assessment of disease activity is essential for effective patient management. Endoscopy is the gold standard for evaluating mucosal inflammation, but non-invasive alternatives, such as transabdominal ultrasound (TAUS), are garnering interest.

Aims & Methods

This study aimed to evaluate the sensitivity of rectal wall thickness measurements using TAUS in assessing disease activity in ulcerative colitis, and to identify an ideal cut-off threshold by comparing results with endoscopic and histological findings.
In a prospective, observational study, we enrolled consecutive patients with UC who were referred to our tertiary center from May 2024 to April 2025. Eligibility required a scheduled TAUS within 30 days of a staging colonoscopy, without intervening therapy adjustments. Exclusion criteria included technically inadequate TAUS readings (e.g., due to anatomical variations or excessive gas interposition) and minor-aged patients. Each patient underwent TAUS performed by a single, experienced operator. A second experienced operator blind assessments were recorded to evaluate inter-observer variability. Rectal wall thickness was measured and compared with clinical, laboratory (CRP, fecal calprotectin), and endoscopic (MAYO score) indicators of disease activity. Histological status (active/inactive) and additional clinical data, including disease duration, extent, and therapy, were recorded.

Results

A total of 74 patients were analyzed, of whom 51.4% were female, with a median age of 55 years (IQR: 42–68). The majority presented with left-sided colitis (Montreal E2, 62.2%), followed by extensive colitis (E3, 25.7%) and proctitis (E1, 12.1%). The median disease duration was 12 years (IQR 5–23). Patients with an endoscopic MAYO score of 0 or 1 had a median rectal wall thickness of 4.95 mm (IQR 4.5–5.88), while those with a score of 2 or 3 had a median of 6.15 mm (IQR 5.3–6.7; p=0.003). Receiver Operating Characteristic (ROC) analysis for TAUS rectal wall thickness showed good discriminatory ability for endoscopic activity (cut-off: 5.55 mm, AUC 0.725, 95CI 0.597-0.853, Se 0.80, Sp 0.71), comparable to fecal calprotectin (cut-off: 277 µg/g, AUC 0.717, 95CI 0.589-0.845, Se 0.70, Sp 0.66; p=0.256) and superior to CRP (cut-off: 1 mg/L, AUC 0.511, 95CI 0.357-0.664, Se 0.50, Sp 0.50; p<0.0001). For histological activity, TAUS again performed well (cut-off: 5.55 mm, AUC 0.794, 95CI 0.682-0.906, Se 0.76, Sp 0.80), closely matching fecal calprotectin (cut-off 302, AUC 0.744, 95CI 0.627-0.861, Se 0.69, Sp 0.73; p=0.425) and outperforming CRP (cut-off 1.5, AUC: 0.631, 95CI 0.497-0.765, Se 0.62, Sp 0.63; p<0.0001). Inter-observer agreement for TAUS rectal wall thickness was excellent, with an intraclass correlation coefficient of 0.923 (p<0.0001), underscoring the reproducibility of this non-invasive method.

Conclusion

TAUS measurement of rectal wall thickness demonstrates promising sensitivity and reproducibility in detecting mucosal and histological activity in UC, aligning closely with established markers such as fecal calprotectin. A cut-off value of 5.55 mm showed good discriminatory performance in this cohort, suggesting potential utility as a non-invasive marker of disease activity..Given its non-invasive nature, low cost, and strong inter-observer agreement, TAUS is a valuable adjunct for routine UC monitoring. Combined with clinical and biochemical data, it may reduce the need for repeated endoscopy, minimizing patient burden, healthcare costs, and environmental impact.

Event

UEG Week Berlin 2025

Topics

IBD Radiology & Imaging

Submission format

Abstract

Session

Monitoring IBD by imaging

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

Therapy update EoE: Conventional treatment and treatment options for children

Ulrike von Arnim

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Wendi LeBrett

LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

Ian White

EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

Elisa Marabotto

ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

Knut E.A. Lundin

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

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ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

Ingrid Prytz Berset 1, Frode Lerang 2, Dag Arne Lihaug Hoff 3, Knut E.A. Lundin 4

Affiliations

1 Gastroenterology Aalesund, Alesund, Norway

2 Central Hosspital of Ostfold, Grålum, Norway

3 Aalesund Hospital, Møre & Romsdal Hospital trust, Aalesund, Norway

4 K. G. Jebsen Coeliac Disease Research Centre, University of Oslo and Oslo University Hospital, Oslo, Norway

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Abstract

Introduction

The BIOSTOP Trial is a prospective, multicenter, randomized, controlled, open-label study conducted in Norway to evaluate the two-year outcomes of tumor necrosis factor-alpha (anti-TNF) antibody withdrawal in patients with ulcerative colitis (UC) in sustained clinical and endoscopic remission. Prior non-randomized studies have suggested that approximately half of such patients maintain remission after anti-TNF discontinuation and that reintroduction of anti-TNF therapy is generally effective and safe in the event of relapse.

Aims & Methods

A total of 174 UC patients in confirmed clinical and endoscopic remission were enrolled across 19 gastroenterology centers between June 2017 and December 2020 and randomized 1:1 to either continue or discontinue anti-TNF therapy. Eligibility criteria included at least 12 months of first-line anti-TNF maintenance treatment, clinical remission, fecal calprotectin <200 µg/g, and endoscopic remission (Mayo endoscopic score 0 or 1). Two-year follow-up data were available for 172 patients (86 in each group). In 156 of the patients endoscopies were available for central reading (77 in the withdrawal group and 79 in the maintenance group). The primary endpoint was sustained endoscopic remission at two years.

Results

At two years, central reading of follow-up colonoscopies confirmed endoscopic remission in 64 of 77 patients (83%, 95% CI 71.8 – 93.1) in the anti-TNF withdrawal group, compared to 77 of 79 patients (96 %, 95 % CI 92.1 – 100.8) in the anti-TNF maintenance group. The non-inferiority primary endpoint of the study was thus not met. During the study period, 48% of patients in the withdrawal group and 88% in the maintenance group remained in sustained clinical and endoscopic remission without relapse. Among the 45 patients in the withdrawal group who experienced endoscopic confirmed relapse, 28 (62%) resumed anti-TNF therapy, with 26 achieving both clinical and endoscopic remission. Additionally, 10 of 13 patients with mild relapses achieved endoscopic remission with optimized non-biologic therapy. There were no difference in serious adverse events between the groups.

Conclusion

After two years, 83% of patients in the anti-TNF withdrawal group and 96% in the maintenance group were in clinical and endoscopic remission, including those who experienced flares and achieved new remission after reintroduction of anti-TNF or optimized non-biologic therapy. Nearly half of the patients maintained remission without anti-TNF, and the majority of relapses were effectively managed. These findings suggest that anti-TNF withdrawal is a safe option for selected UC patients in confirmed remission, provided they are monitored closely.
Trial Registration: ClinicalTrials.gov Identifier: NCT03011268; EudraCT Number: 2016-001409-18. Trial completion date: 31 January 2025.

Disclosure

No disclosures

Event

UEG Week Berlin 2025

Topics

Endoscopy IBD

Submission format

Abstract

Session

Tackling IBD in clinics

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

GENE VARIANTS IN CAPN14, IL13, STAT6 AND ABCB1 GENES WERE ASSOCIATED WITH ESOPHAGEAL FEATURES AND ALLERGIC CONCOMITANCES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Verónica Martín Domínguez

Therapy update EoE: Conventional treatment and treatment options for children

Ulrike von Arnim

How to fight fake news in medicine?

Wendi LeBrett

LONG-TERM OUTCOMES OF CUFFITIS IN PATIENTS AFTER TOTAL PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS DUE TO ULCERATIVE COLITIS

Ian White

EVALUATION OF RECTAL WALL THICKNESS MEASUREMENT SENSITIVITY VIA TRANSABDOMINAL ULTRASOUND TO ASSESS MUCOSAL ACTIVITY IN ULCERATIVE COLITIS: COULD THIS BE A USEFUL NON-INVASIVE TOOL?

Elisa Marabotto

ANTI-TNF TREATMENT WITHDRAWAL IN ULCERATIVE COLITIS, A MULTICENTER, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL

Knut E.A. Lundin

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