Evaluation of pathological findings that can be used to predict post-surgery recurrence in Crohn's disease

ABSTRACT Objective: People diagnosed with Crohn's disease which is one of the inflammatory bowel diseases may undergo surgery one or more times in their lives if intestinal involvement is resistant to medical therapy. The Rutgeerts score, which describes endoscopic recurrence, is widely used to predict clinical recurrence after surgery. Our aim in this study is to evaluate the relationship between the microscopic and macroscopic pathological features in the removed resection materials and the Rutgeerts scores of the patients in order to predict endoscopic recurrences in the operated Crohn's disease patients with intestinal involvement. Materials and Methods: In our study 32 patients over the age of eighteen, diagnosed with Crohn's disease with intestinal involvement, who we operated at Ankara Bilkent City Hospital General Surgery Clinic between November 2019 and October 2023, were retrospectively evaluated. The resection materials of the patients were re-examined histopathologically and scoring was made. Postoperative follow-up colonoscopy reports were examined and classified according to the Rutgeerts score. The relationship of the obtained data was compared. Results: Postoperative colonoscopy Rutgeerts scores of the patients and macroscopic and microscopic findings in the resection materials were statistically evaluated. It was determined that macroscopic findings were not related to Rutgeerts scores and endoscopic recurrence. From the microscopic findings, it was determined that the presence and severity of neutrophilic cryptitis and crypt abscess increased in parallel with the Rutgeerts score and were statistically significant. It was determined that other microscopic findings were not related to Rutgeerts scores and endoscopic recurrence. Conclusion: The presence of neutrophilic cryptitis and crypt abscesses which are histological findings seen in intestinal resection material in Crohn's disease, increases the possibility of endoscopic recurrence. It may be useful to perform close endoscopy control in high-risk patients and start medical treatment early in the postoperative period to prevent recurrence. Keywords: Crohn's Disease, Endoscopic Relapse, Pathological Features, Rutgeerts Score