Postoperative prevention of recurrence of Crohn's disease

Abstract

Although the therapy of CD is primarily medical, surgery still plays an important role in its management. The high incidence of postoperative CD recurrence is, however, a major drawback. We provide a clear and practical algorithm which will help the clinician to decide when and what kind of prophylactic treatment is indicated. Strategies to prevent recurrence start with a careful selection of patients to send for surgery, based on the known risk factors of recurrence. Current evidence suggests only a moderate effect of the known active agents in the prevention of postoperative CD recurrence. Only patients at higher risk for recurrence should continue on, or be treated with, immunosuppressives (6-MP or azathioprine) after surgery. All others can be followed clinically, or alternatively should undergo an ileocolonoscopy 3-12 months after surgery. If severe endoscopic recurrence is seen, therapy is indicated to prevent the imminent clinical symptoms, or eventually a new resection. Much is anticipated from newer biological agents potentially interacting with earlier steps in the pathogenesis of recurrent CD. © 2005 Springer Science+Business Media, Inc.