Reducing the incidence of post-operative recurrence in Crohnís disease patients

The long-term management of Crohnis disease remains a challenge. The gastroenterologist is often faced with intractable or complicated forms of the disease that make surgical intervention unavoidable despite the numerous options of conservative treatment available. Almost 80% of Crohnis patients will require surgical resection eventually. The recurrence rate after surgical resection is very high. Within one year after operation as many as 95% of patients will exhibit endoscopic recurrence of the disease, while by the third post-operative year clinical recurrence is as high as 65%. The neccessity of reoperation increases with time after the first resection. As many as 38% of the patients will require a second resection within 5 years, 57% within a decade and as many as 71%, twenty years down the line. Numerous medical treatments have been tried in an attempt to significantly decrease the post-surgical recurrence of Crohnis. Sulfasalazine and mesalazine, metronidazole and ornidazole, prednisolone and budesonide and finally azathioprine and 6-mercaptopurine are the main drugs tried in numerous trials over the last 25 years. Historically, sulfasalazine was first tried in an attempt to maintain remission after surgical resection. However, placebo-controlled trials failed to show any significant benefit. 1,2,3