Preventing Postoperative Crohn’s Disease Recurrence

Although the advent of novel medical therapies has broadened the management options for Crohn’s disease, many patients still undergo surgical resection. Management of postoperative Crohn’s disease poses a difficult dilemma as disease recurrence is often clinically silent yet progressive and can lead to future complications requiring additional surgery. Off medical therapy, endoscopic disease recurrence approaches 90% at one year and symptomatic recurrence may reach 60% at 3 years. Several medical treatments for the prevention of postoperative recurrence have been studied, including antibiotics, mesalamine, budesonide, thiopurines, and anti-TNF therapies. The data suggests a benefit of early pharmacological prophylaxis over endoscopy-guided pharmacological treatment, particularly in those who are at moderate- to high-risk for disease recurrence. Regardless of treatment, all patients who have undergone surgically induced remission of Crohn’s disease should undergo postoperative endoscopic surveillance at 6 to 12 months. Further comparative studies are warranted to help define the optimal patient characteristics for recurrence and the optimal timing to introduce postoperative treatment.