Management of postoperative Crohn’s disease

Abstract

Surgical treatment does not cure Crohn’s disease, and postoperative recurrence is a feature of the clinical course of the disease. Ileocolonoscopy remains the gold standard for the surveillance of recurrent Crohn’s disease and should be performed 6–12 months after an operation. Many other non-invasive techniques are also useful and complement endoscopy for the early diagnosis of postoperative recurrence. Anti-TNF agents show great efficacy for the prevention of postoperative recurrence, and long-term use can maintain remission. It remains undetermined whether early treatment after postoperative endoscopic recurrence is ultimately as efficacious as prophylactic therapy.

Keywords::

• anti-TNF agents
• Crohn’s disease
• ileocolonoscopy
• infliximab
• non-invasive
• postoperative recurrence
• surgery
• top-down

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Surgical treatment of Crohn’s disease (CD) is not curative, and the majority of patients will suffer from relapse.

• Ileocolonoscopy remains the gold standard for the evaluation of postoperative CD recurrence and should be performed 6–12 months after surgery.

• Other non-invasive techniques are useful complementary tools for diagnosing early postoperative recurrence of Crohn’s, of which contrast-enhanced ultrasonography and fecal biomarkers show promising results.

• Anti-TNF agents have shown great efficacy, both as preventive therapy immediately after surgery and in the early treatment after endoscopic recurrence has already occurred.

• Anti-TNF agents can maintain remission and mucosal healing of postoperative CD over the long term.

• Results from ongoing randomized trials and updated data from the published trials with long-term follow-up will provide more convincing evidence regarding the use of biologics for CD in the postoperative setting.