Anti-TNF's for postoperative recurrence in Crohn's disease: the if's and how's

Recurrence of Crohn's disease (CD) is extremely frequent after surgery and its prevention remains a fundamental problem in the medical management of these patients. As of today, none of the medications traditionally used to treat the spontaneous disease (i.e. mesalamine, steroids, immunosuppressives and antibiotics) has shown a clear benefit. Recent data, coming from our center and from a small RCT do indicate that infliximab is extremely effective in preventing this complication in the large majority of patients. While additional, larger studies may be desirable, the strength and consistency of the available data suggest that future trials may merely confirm these observations. A number of issues however remain to be solved and include the long term strategy in patients treated for years with infliximab, whether treating early endoscopic lesions may be as effective as preventing them and whether immunosuppressives should be used together with infliximab. A thorough understanding of the mechanisms by which infliximab appears so effective in the postoperative setting may provide us with essential information regarding patients' management and, ultimately, highlight the molecular mechanisms at the very basis of Crohn's disease.