[Prevention of Crohn disease recurrence]

Drug treatment does not play a significant role either in the maintenance of remission induced by drugs or surgery in Crohn's disease. Considering the data available, it is reasonable that after resection of involved bowel segments an attempt is made to avoid relapses using a suitable 5-ASA preparation. This remains an individual decision following explanation of the pros and cons of the treatment to the patient. The application of immunosuppressants such as azathioprine or 6-mercaptopurine is probably more effective but hampered by a higher rate of side effects. This approach is therefore not to be generally recommended at this time. New approaches such as antibodies against tumor necrosis factor are of interest but can also currently not be recommended for practical treatment. In conclusion, at this time no drug can be recommended for remission maintenance which is safe and effective. The use of the different possibilities described remains at the discretion of the treating physician depending on the individual situation (localization of disease, extent of operative intervention and history regarding relapses). Only a better understanding of etiology and pathogenesis and possible subtyping of patients with Crohn's disease can lead to better and more effective measures of remission maintenance.