Intestinal fibrosis attenuates the prophylactic effect of anti-tumour necrosis factor therapy on the postoperative recurrence of Crohn's disease.

Background: In the biologic era, postoperative recurrence (POR) of Crohn's disease (CD) remains a significant concern. The underlying cause of this phenomenon remains unclear at present.

Aim: To examine whether intestinal fibrosis increases the likelihood of POR when anti-tumor necrosis factor biologics are used following ileocecal resection (ICR).

Methods: We performed a single-centre, retrospective cohort study of patients with CD who underwent ICR. Recurrence was defined by endoscopy (Rutgeerts score ≥ i2), radiography (active inflammation in the neoterminal ileum) or surgery (another resection > 3 months post-ICR), and patients were categorised by the presence of intestinal fibrosis on histopathological evaluation.

Results: Among 102 patients with CD who underwent ICR and received infliximab within 3 months, 69 (67.6%) had intestinal fibrosis. In addition, 60 patients (58.8%) experienced POR in various forms: 52.6%, 41.2%, and 10.8% had endoscopic, radiographic, and surgical recurrence, respectively. Patients with intestinal fibrosis experienced faster radiographic recurrence (log rank P = 0.03). After adjusting for risk factors associated with POR, intestinal fibrosis increased the risk of early radiographic recurrence (adjusted hazard ratio = 4; 95% confidence interval: 1.03-15.56; P = 0.045).

Conclusion: Despite the limited sample size, our study revealed a strong correlation between radiographic POR and intestinal fibrosis in patients who received postoperative anti-tumor necrosis factor α prophylaxis.