Year 1990: Predictability of the postoperative course of Crohn's disease

In this elegant study done in the “European capital of IBD”, professor Rutgeerts describes the evolution of patients with Crohn's disease who undergo resective surgery. This paper has become the cornerstone upon which the other studies on postoperative recurrence of Crohn's disease rest. The authors conducted an exhaustive study of postoperative patients over 5 years at their site. It should be noted that this clearly describes that the severity of the endoscopic lesions observed via ileoscopy at the end of one year is the best predictive factor of evolution of postoperative patients in the medium-long term. Another less well-known part of the study, demonstrates that despite having conducted “curative” resections on 22 patients (defined as those in which no macroscopically affected ileum was left, seen in detail during the intervention), almost all of them developed endoscopic ileal lesions associated with microscopic inflammation during follow-up. In said patients, at the time of the intervention, biopsies were taken prior to conducting the anastomosis, being completely normal in 19 of the 22 patients. This study clearly suggests that early lesions that appear in the terminal neoileum of postoperative patients with Crohn's disease are not due to underlying microscopic inflammation but to de novo inflammation of said area.