Correlation Between the Rutgeerts Score and Clinical Recurrence in Crohn's Disease

Crohn’s disease frequently recurs after ileocolic resection, with endoscopic lesions often preceding clinical relapse. The Rutgeerts score, widely used to evaluate postoperative recurrence, provides a reliable measure of mucosal healing and disease activity. In this retrospective study including 92 patients operated at Ibn Sina University Hospital between 2019 and 2025, we assessed the correlation between postoperative Rutgeerts scores and clinical outcomes during a three-year follow-up. Endoscopic recurrence (Rutgeerts ≥ i2) was observed in 45.6% of patients, while 39.1% developed clinical relapse. Recurrence rates increased progressively with higher scores, ranging from 4.5% in i0 to 100% in i4. Notably, the subclassification of i2 lesions revealed distinct prognostic implications, with clinical relapse occurring in 18.7% of i2a versus 75% of i2b patients. Multivariate analysis identified a Rutgeerts score ≥ i2 as the only independent predictor of recurrence (aOR 3.2, 95% CI 2.6–28; p < 0.001). These findings confirm the strong association between endoscopic and clinical recurrence, highlight the clinical relevance of the i2a/i2b distinction, and support the role of the Rutgeerts score as a key tool in postoperative risk stratification and therapeutic decision-makin.