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Postoperative Recurrence of Crohn's Disease: Pathophysiology, Diagnosis and Treatment
Antonio Di Sario1, Paola Sassaroli1, Luigi Daretti1
1Clinic of Gastroenterology and Hepatology and #Dermatological Unit, Ospedali Riuniti University Hospital, Via Conca 71, 60126 Ancona, Italy.
Background:
Abstract: Up to 80% of Crohn's disease (CD) patients require at least one surgical intervention in their lifetime and up to 70% of these patients develop postoperative endoscopic recurrence within 1 year.
Methods:
The most important predictors of early postoperative recurrence are represented by smoking, prior intestinal surgery, penetrating disease and perianal location. Genetic factors, gut microbiota structure and immunological alterations may be involved in the pathogenesis of postoperative recurrence of CD, although their specific roles have to be determined yet.
Results:
Different drugs, such as metronidazole, thiopurines and anti-tumor necrosis factor α (anti- TNFα) have been shown to reduce the risk of recurrence in many clinical trials, although the choice of the drug should take into consideration the benefits, the potential side effects and also the costs. Patients who are at high risk for postoperative recurrence should be considered for early medical prophylaxis with thiopurines or anti-TNFα drugs; on the contrary, patients who do not have risk factors may receive no treatment or receive a course of antibiotic or mesalazine followed by tailored therapy based on endoscopy at 6 months.
Conclusion:
Therefore, stratifying patients according to their risk of recurrence and tailoring therapy are at present the ideal and most cost-effective ways to treat operated CD patients, although many aspects require further evaluation.