Prevention of post-operative recurrence of Crohn's disease

Byron Philip Vaughn, Alan Colm Moss

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1147-1154
Number of pages8
JournalWorld journal of gastroenterology
Volume20
Issue number5
DOIs
StatePublished - Feb 7 2014

Keywords

  • Biologics
  • Crohn's disease
  • Inflammatory bowel disease
  • Medical treatment
  • Postoperative recurrence

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