Prevention and Treatment Options for Postoperative Crohn's Disease: A Clinical Dilemma

The majority of patients with Crohn's disease require surgery for disease-related complications. Postoperative Crohn's disease recurrence is common after intestinal resection. The optimal management strategy for postoperative recurrence of Crohn's disease is controversial. In the absence of universally adopted guidelines, clinicians and patients must discuss and weigh the risks and benefits of postoperative pharmacotherapy. Those patients at low risk of disease recurrence may not require treatment. On the other hand, patients with more aggressive disease and high risk of recurrence may be best treated early in the postoperative period with an immunomodulator or antitumor necrosis factor agents. Ideally, postoperative treatment decisions would be made using predictable, reliable, and reproducible clinical prediction criteria that would guide treatment. This article reviews the data on postoperative Crohn's disease, including predictors of early recurrence, available options for postoperative monitoring, timing of initiation, and choice of postoperative therapy for prevention and management.