Prevention of Post-operative Recurrence in Crohn's Disease

Kim, Hyo Jong

Abstract

At one year after a first resection in patients with Crohn's disease, up to 80% of patients show endoscopically-determined recurrence of disease, 10-20% have a clinical relapse and 5% have to undergo surgery again. However, there are currently no guidelines for the postoperative maintenance therapy for patients with Crohn's disease, and considerable uncertainty remains as to the efficacy of the various postoperative treatments. New lesions can be visualized endoscopically within weeks to months after performing ileal resection and creating an ileocolonic anastomosis in the neoterminal ileum. The evolution of these lesions mimics the natural history of ileal Crohn's disease at the onset. If we are able to prevent the recurrence of early lesions, then we will probably interrupt the natural course of this disease. Since there is a lag time of months to years between the development of recurrent lesions in the bowel and the recurrence of symptoms, we recommend performing endoscopy of the bowel 6 months after the initial operation to assess the severity of recurrence, and the strategy for further treatment should be based on this assessment. The development of explicit criteria for the appropriateness of various postoperative treatment regimens is needed to aid physicians when they making the clinical decisions in this context.