title: Prevention of post-operative recurrence of Crohn's disease.
abstract: Endoscopic and clinical recurrence of Crohn's disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk of recurrence. A number of medical therapies have been shown to reduce this risk in clinical trials. Metronidazole, thiopurines and anti-tumour necrosis factors (TNFs) are all effective in reducing the risk of endoscopic or clinical recurrence of CD. Since these are preventative agents, the benefits of prophylaxis need to be weighed-against the risk of adverse events from, and costs of, therapy. Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF. Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year. Clinical recurrence rates are variable, and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.
authors.affiliation: Byron Philip Vaughn, Alan Colm Moss, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Boston, MA 02115, United States.
authors.forename: Byron Philip
authors.initials: BP
authors.lastname: Vaughn
authors.affiliation: Byron Philip Vaughn, Alan Colm Moss, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Boston, MA 02115, United States.
authors.forename: Alan Colm
authors.initials: AC
authors.lastname: Moss
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics; D016527:Drug Costs; D016099:Endoscopy, Gastrointestinal; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents
keywords: Biologics; Crohn’s disease; Inflammatory bowel disease; Medical treatment; Postoperative recurrence