P5482 - Prognostic Value of Modified Rutgeerts Score (i2a vs i2b) in Postoperative Crohn’s Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis
University of Colorado Anschutz Medical Campus Denver, CO
Award: ACG Presidential Poster Award
Hayder Alamily, MD1, Sana Rabeeah, MD2, Omer Najem, MD3, Ban Mashadani, MD4, Sandra Chehayeb, MD5, Mohamed A. Omar, MD5, Abdulrahman Khaldoon. Hamid, MD6, Bisher Sawaf, MD7, Hasan Al-Obaidi, MD8, Lauren Tong, MLIS9, Salam Bachour, MD, MSc10, Ravi S. Shah, MD11, Miguel Regueiro, MD12, Edward L. Barnes, MD, MPH13, Jordan Axelrad, MD, MPH14, Asad Ur Rahman, MD15, Benjamin L. Cohen, MD16, Benjamin Click, MD, MS17 1University of Colorado Anschutz Medical Campus, Denver, CO; 2The University of Toledo, Toledo, OH; 3Department of internal medicine, Trinity Health Oakland, Pontiac, MI; 4Baptist Health-University of Arkansas for Medical Sciences, North Little Rock, AR; 5University of Kansas School of Medicine, Wichita, KS; 6Jamil Tutanji Hospital, Amman, 'Amman, Jordan; 7University of Toledo Medical Center, Toledo, OH; 8University of Toledo College of Medicine and Life Sciences, Toledo, OH; 9University of Arkansas for Medical Sciences, Little Rock, AR; 10Brigham and Women's Hospital, Boston, MA; 11Wake Forest University School of Medicine, Winston-Salem, NC; 12Cleveland Clinic, Cleveland, OH; 13Multidisciplinary Inflammatory Bowel Diseases Center, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Chapel Hill, NC; 14Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York, NY; 15Cleveland Clinic Florida, Weston, FL; 16Cleveland Clinic Foundation, Cleveland, OH; 17University of Colorado, Denver, CO Introduction: Following resection for Crohn’s disease (CD), the prognostic significance of Rutgeerts’ i2a (isolated anastomotic lesions) versus i2b ( >5 ileal aphthous lesions with or without anastomotic lesions) remain controversial. Prior meta-analyses did not include recent large cohorts and used variable outcome definitions. We performed an updated meta-analysis of all available data and outcomes to examine the clinical impact of i2a vs i2b stratification. Methods: A PRISMA-compliant systematic review was conducted using PubMed, Embase, and Cochrane databases for English-language studies reporting outcomes by i2 subclassification. Included studies reported clinical, endoscopic, surgical, or severe recurrence. Meta-analysis was performed using RevMan 5.4. Risk of bias was assessed using RoB 2.0 and ROBINS-I. Meta-regression and leave-one-out sensitivity analyses were performed in R, exploring the effects of publication year, sample size, and follow-up duration. Publication bias was evaluated using funnel plots. Results: Ten studies (n=2,531) spanning 2016-2024 were included and analyzed. Cumulative risk estimates showed 5-year clinical recurrence rate of 65% (i2a) vs 79% (i2b), 5-year endoscopic recurrence rates of 47% vs 51%, and 5-year surgical recurrence rates of 30% vs 32%. Compared to i2b, i2a was associated with significantly lower clinical recurrence (RR 0.74, 95% CI [0.68–0.79], p< 0.00001, I²=0%), endoscopic recurrence (RR 0.61, 95% CI [0.51–0.73], p< 0.00001, I²=0%), and severe endoscopic progression (RR 0.66, 95% CI [0.50–0.87], p=0.003, I²=0%). No significant differences were found in surgical recurrence (RR 0.92, 95% CI [0.58–1.47], p=0.73, I²=45%) or global recurrence (RR 1.24, 95% CI [0.84–1.85], p=0.28, I²=0%). Funnel plots showed no publication bias. Meta-regression identified publication year and sample size as sources of heterogeneity; follow-up duration had no effect. Sensitivity analysis confirmed robustness of the findings. Discussion: In postoperative Crohn’s disease monitoring, i2a lesions are associated with significantly lower rates of clinical, endoscopic, and severe recurrence compared to i2b, emphasizing the clinical prognostic utility of the modified Rutgeerts’ score. Prospective studies are warranted to guide tailored management strategies.
Figure: Forest plots
Figure: cumulative risk plots
Disclosures: Hayder Alamily indicated no relevant financial relationships. Sana Rabeeah indicated no relevant financial relationships. Omer Najem indicated no relevant financial relationships. Ban Mashadani indicated no relevant financial relationships. Sandra Chehayeb indicated no relevant financial relationships. Mohamed Omar indicated no relevant financial relationships. Abdulrahman Hamid indicated no relevant financial relationships. Bisher Sawaf indicated no relevant financial relationships. Hasan Al-Obaidi indicated no relevant financial relationships. Lauren Tong indicated no relevant financial relationships. Salam Bachour indicated no relevant financial relationships. Ravi Shah indicated no relevant financial relationships. Miguel Regueiro: AbbVie – Advisory Committee/Board Member, Consultant. Amgen – Advisory Committee/Board Member, Consultant. BMS – Advisory Committee/Board Member, Consultant. Boehringer Ingelheim Pharmaceuticals Inc. – Advisory Committee/Board Member, Consultant. Celegene – Advisory Committee/Board Member, Consultant. Eli Lilly and Company – Advisory Committee/Board Member, Consultant. Genentech – Advisory Committee/Board Member, Consultant. Gilead – Advisory Committee/Board Member, Consultant. Janssen – Advisory Committee/Board Member, Consultant. Organon – Advisory Committee/Board Member, Consultant. Pfizer – Advisory Committee/Board Member, Consultant. Prometheus – Advisory Committee/Board Member, Consultant. Salix – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant. UCB – Advisory Committee/Board Member, Consultant. Edward Barnes: AbbVie, Inc. – Consultant. Boomerang – Consultant. Eli Lilly – Consultant. Eli Lilly – Grant/Research Support. Pfizer – Consultant. Sanofi – Consultant. Takeda – Consultant. Target RWE – Consultant. Jordan Axelrad: Abbvie – Advisory Committee/Board Member, Consultant, Honorarium. Abivax – Advisory Committee/Board Member, Consultant, Honorarium. Adiso – Advisory Committee/Board Member, Consultant, Honorarium. BioFire Diagnostics – Grant/Research Support. Biomerieux – Advisory Committee/Board Member, Consultant, Honorarium. Bristol-Myers Squibb – Advisory Committee/Board Member, Consultant, Honorarium. Celltrion – Advisory Committee/Board Member, Consultant, Honorarium. Ferring – Advisory Committee/Board Member, Consultant, Honorarium. Fresenius – Advisory Committee/Board Member, Consultant, Honorarium. Genentech – Grant/Research Support. Janssen – Advisory Committee/Board Member, Consultant. Janssen – Grant/Research Support. Janssen – Honorarium. Johnson & Johnson – Advisory Committee/Board Member, Consultant. Merck – Advisory Committee/Board Member, Consultant, Honorarium. NIH NIDDK Diseases K23DK124570 – Grant/Research Support. Pfizer – Advisory Committee/Board Member, Consultant, Honorarium. Sanofi – Advisory Committee/Board Member, Consultant, Honorarium. The Crohn's and Colitis Foundation (#878246) – Grant/Research Support. The Judith & Stewart Colton Center for Autoimmunity – Grant/Research Support. Vedanta – Advisory Committee/Board Member, Consultant, Honorarium. Asad Ur Rahman: Abbvie Inc – Speakers Bureau. Benjamin Cohen: Abbvie – Advisory Committee/Board Member, Consultant, Speakers Bureau. ALPCO – Advisory Committee/Board Member, Consultant. Emmes Biopharma Services LLC – DSMB. J&J Innovative Medicine – Advisory Committee/Board Member. Pfizer – Advisory Committee/Board Member. Takeda – Consultant, Speakers Bureau. Benjamin Click indicated no relevant financial relationships.
Hayder Alamily, MD1, Sana Rabeeah, MD2, Omer Najem, MD3, Ban Mashadani, MD4, Sandra Chehayeb, MD5, Mohamed A. Omar, MD5, Abdulrahman Khaldoon. Hamid, MD6, Bisher Sawaf, MD7, Hasan Al-Obaidi, MD8, Lauren Tong, MLIS9, Salam Bachour, MD, MSc10, Ravi S. Shah, MD11, Miguel Regueiro, MD12, Edward L. Barnes, MD, MPH13, Jordan Axelrad, MD, MPH14, Asad Ur Rahman, MD15, Benjamin L. Cohen, MD16, Benjamin Click, MD, MS17. P5482 - Prognostic Value of Modified Rutgeerts Score (i2a vs i2b) in Postoperative Crohn’s Disease: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
