Management of post-operative Crohn's disease in 2017: where do we go from here?
Postoperative recurrence (POR) of Crohn's disease is common after surgical resection. How to best manage POR remains uncertain. Areas covered: In this review, we will first describe the natural course and the best modalities to diagnose this surgical sequela. We will then focus on the potential risk factors for relapse and highlight the main shortcomings in the current study designs and endoscopic and clinical scoring systems, which may partly explain the unexpected outcomes of recent clinical trials. Finally, we will propose a strategy to address the management of POR. Expert commentary: Anti-tumor necrosis factor (Anti-TNF) agents are the most effective therapy to prevent POR in Crohn's disease. Patient risk stratification and active monitoring with scheduled ileocolonoscopy are cornerstones of optimal POR management. Further studies are needed to address areas of uncertainty including timing and duration of therapy and the role of therapeutic drug monitoring in this setting.
a Gastroenterology , Virginia Tech - Carilion School of Medicine , Roanoke , VA , United States.
Vu
V
Nguyen
a Gastroenterology , Virginia Tech - Carilion School of Medicine , Roanoke , VA , United States.
Rajan
R
Kanth
a Gastroenterology , Virginia Tech - Carilion School of Medicine , Roanoke , VA , United States.
Joshua
J
Gazo
a Gastroenterology , Virginia Tech - Carilion School of Medicine , Roanoke , VA , United States.|b Clinical and Experimental Medical Sciences , University of Udine Medical School , Udine , Italy.
Dario
D
Sorrentino
D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D016903:Drug Monitoring; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D011237:Predictive Value of Tests; D012008:Recurrence; D019233:Retreatment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D000893:Anti-Inflammatory Agents; D001688:Biological Products; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha
Crohn’s disease; anti-TNF agents; biologics; endoscopic scoring system; post-operative Crohn’s disease