[Problems related to postoperative clinical relapse and endoscopic recurrence in Crohn's disease]

Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Up to 70% of patients with Crohn's disease will undergo intestinal resection during the course of their disease for complications, but also for the control of symptoms when medical therapy is not useful. At 1 year after a first resection, up to 70% of patients show an endoscopic recurrence and 20-30% have clinical relapse. Ileocolonoscopy is considered the gold standard for postoperative recurrence assessment. Several other risk factors for postoperative recurrence have been identified such as smoking, the disease activity before surgery, the ileocolonic disease, the younger age, the fistulising disease. Several different therapeutic approaches have been evaluated in the prevention of postoperative recurrence. In clinical practice, mesalazine is the first-line treatment used in the postoperative setting, despite considerable controversy as to its efficacy. Immunosuppressive treatment is based on scant evidence but is currently used as a second-line treatment in post-surgical patients at high risk for recurrence, with severe symptoms or with early endoscopic lesions in the neoterminal ileum. Biologic therapy (infliximab) is a candidate new therapy but further controlled trials are needed.