Postoperative Recurrence of Crohn Disease Linked to Sex and Ethnicity

Male nurse holding digital tablet consulting with patient in exam room
A team of researchers investigated the association between postoperative recurrence of Crohn disease and a patient’s sex and race and ethnicity.

Male sex and belonging to a racial and ethnic group that includes Black, Asian, or “other” significantly increased risk for postoperative recurrence of Crohn disease (CD) following ileal resection, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Researchers conducted a prospective cohort study of 305 patients with CD who underwent ileal resection in 6 centers throughout North America to determine the effects of sex and race and ethnicity on postoperative relapse.

In the cohort, 152 of the 305 patients (49.8%) were women, 32 (10.5%) identified as “non-White,” 30 (9.8%) actively smoked following surgery, 124 (40.7%) used tumor necrosis factor antagonists (TNFa), 80 (26.2%) had a previous history of ileal resection, and 172 (56.4%) demonstrated penetrating disease behavior, as determined by the Montreal classification for CD.

The attending gastroenterologist evaluated the patients for CD recurrence, which was identified by a Rutgeerts score greater than or equal to i2.

Postoperative recurrence of CD occurred in 93 (30%) of the 305 patients at the time of first postoperative colonoscopy.

Researchers identified male sex (adjusted odds ratio [aOR], 2.2 [1.3-3.7]), non-White race (aOR, 3.2 [1.4-6.9]), active smoking (aOR, 2.7 [1.2-6.0]), and lack of exposure to TNFa (aOR, 2.8 [1.5-4.9]) as factors increasing risk for CD recurrence following surgery.

Regardless of patient exposure to effective therapies, such as inflammatory bowel disease medications after ileal resection, male sex and belonging to racial and ethnic groups, such as Black, Asian, or “other,” still increased risk for postoperative recurrence. Other risk factors, including previous history of intestinal resections, disease behavior, and the duration of time between the resection and the endoscopy, did not influence likelihood of postoperative recurrence of CD.

“[Sex] and ethnicity appear to be related to postsurgical outcomes in CD,” the study authors wrote. “It is unclear if these differences are related to economic, health care access disparities, adherence to therapy, or true biologic effect.”


Hernandez-Rocha C, Schumm LP, Birch S, et al. Male gender and non-Caucasian ethnicity are associated with higher risk of postoperative recurrence of Crohn’s disease independent of known clinical risk factors. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract Su1017.

This article originally appeared on Gastroenterology Advisor