Prevention of postoperative recurrence of Crohn's disease: what does the evidence support?

Patients who have undergone intestinal resection for Crohn's disease frequently develop endoscopic and clinical recurrence of their disease. Active smokers and those with perforating disease appear to be at a higher risk of this development. A number of agents have been shown in randomized controlled trials to reduce the risk of endoscopic and clinical recurrence, but international guidelines are currently ambiguous on which agent should be used. Because there are wide-ranging efficacy estimates, safety profiles, and costs for the various proven prophylactic agents, physicians should personalize the management of individual patients based on their estimated probability of clinical recurrence (low/high). Such risk stratification could be based on the patient's clinical profile with or without early postoperative endoscopic surveillance. Ongoing trials using this "tailored" strategy should provide answers on whether this approach allows optimal selection of proven therapies.