Preventing postoperative recurrence of Crohn's disease.
METHODS
Risk factors for recurrence of Crohn's disease and the evidence for progress in reducing recurrence following resection were reviewed. A Medline based literature review was carried out.


CONCLUSIONS
Only smoking has been confirmed as a significant adverse risk factor for recurrence. Evidence for differing recurrence rates in fibrostenosing disease and perforating disease is inconclusive, but such a classification along with the endoscopic findings of recurrence may have a place in the analysis of therapeutic trials. Minimal resectional surgery with clearing of only macroscopic disease seems to be justified, with no clear benefits from different anastomotic techniques. Recent trials offer encouraging evidence of the usefulness of 5-aminosalicylic acid, particularly higher-dose regimens started early after resection, although the long-term benefits are uncertain. The oral steroid, budesonide, offers a potent treatment with minimal side-effects, but evidence of its prevention of recurrence is presently weak.
Borley
N R
NR
Department of Surgery, John Radcliffe Hospital, Oxford, UK.
Mortensen
N J
NJ
Jewell
D P
DP
D000367:Age Factors; D000714:Anastomosis, Surgical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003107:Colorectal Surgery / Q000379:methods; D003424:Crohn Disease / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery*; D003672:Defecation; D006801:Humans; D011182:Postoperative Care; D012307:Risk Factors; D055502:Secondary Prevention; D012737:Sex Factors; D013997:Time Factors
D000893:Anti-Inflammatory Agents