Preventive therapy in postoperative Crohn's disease.
OBJECTIVE
Recurrence of Crohn's disease following surgical resection is common, but the optimal strategy to assess, prevent, and treat postoperative recurrence remains unclear. Recent developments in the prevention and management of postoperative recurrence have provided additional information.


RESULTS
Predictors of Crohn's disease recurrence after surgery include cigarette smoking, disease behavior, number of prior resections, family history, anastomotic type, and time to first surgery. Only penetrating disease behavior and continued cigarette smoking after surgery remain clear predictors of postoperative Crohn's disease recurrence. Ileocolonoscopy is the only modality to detect mucosal recurrence after surgery; however, surrogate markers of inflammation, specifically stool lactoferrin and calprotectin as well as small intestine contrast ultrasound, are promising. Due to the high rate of surgery for the treatment of complications of Crohn's disease, prevention of postoperative disease has received considerable attention. Recent studies of azathioprine/6-mercaptopurine, nitroimidazole antibiotics, and infliximab have broadened the spectrum of medication options postoperatively.


CONCLUSIONS
Smoking cessation and ileocolonoscopy for early detection of Crohn's disease recurrence should be part of any postoperative management strategy. The selection of medication and optimal time to initiate treatment after surgery is less certain. Postoperative immunomodulators and antitumor necrosis factor agents may prevent Crohn's disease in those at high risk for recurrence. Treatment of patients by predictors of recurrence and personalization of management based on genotypes/phenotypes will be the focus of future study.
Swoger
Jason M
JM
University of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology & Nutrition, Pittsburgh, Pennsylvania 15213, USA.
Regueiro
Miguel
M
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003113:Colonoscopy; D003424:Crohn Disease / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery*; D019160:Endosonography; D005243:Feces / Q000737:chemistry; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007781:Lactoferrin / Q000032:analysis; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D011183:Postoperative Complications / Q000517:prevention & control*; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D039841:Leukocyte L1 Antigen Complex; D007781:Lactoferrin