Is it possible to prevent recurrent Crohn's disease with medical or surgical interventions?
While surgery for Crohn's disease is usually effective initially, its long-term benefits may be diminished by the risk of recurrent disease. In our studies, we have observed symptomatic recurrence rates of 47% and endoscopic recurrence rates of 75% at 3 years. As a result, there has been considerable interest in strategies aimed at decreasing recurrence. Unfortunately, surgical manoeuvers have had little effect on recurrence rates. There are conflicting data on the effect of resection margin length and microscopic disease at the resection margin, probably due to the fact that most data are derived from retrospective studies. Differences in anastomotic technique also appear to have little effect on the recurrence rate. On the other hand, there are now data from two randomized controlled trials supporting the use of 5-aminosalicylic acid postoperatively. In a study performed at the University of Toronto and Mayo Clinic, of 163 patients who were randomized to 5-aminosalicylic acid (Salofalk) 3.0 g/day or placebo, the relative risk of a symptomatic recurrence was 0.628 in the treatment group compared to those in the control group. For compliant patients, the risk reduction was even greater with a RR of 0.532. A similar reduction in the endoscopic recurrence rate was observed. Caprilli and colleagues reported similar results in patients receiving 2.4 g Asacol per day. Postoperative recurrence is a significant problem but is significantly reduced by the prophylactic use of 5-aminosalicylic acid.
Mcleod
R S
RS
Mount Sinai Hospital, University of Toronto, Ontario, Canada.
D000636:Aminosalicylic Acids / Q000627:therapeutic use*; D000714:Anastomosis, Surgical / Q000379:methods; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D019804:Mesalamine; D011182:Postoperative Care; D012008:Recurrence
D000636:Aminosalicylic Acids; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine