Management of post-operative Crohn’s disease in 2017: where do we go from here?

ABSTRACT

Introduction: Postoperative recurrence (POR) of Crohn’s disease is common after surgical resection. How to best manage POR remains uncertain.

Areas covered: In this review, we will first describe the natural course and the best modalities to diagnose this surgical sequela. We will then focus on the potential risk factors for relapse and highlight the main shortcomings in the current study designs and endoscopic and clinical scoring systems, which may partly explain the unexpected outcomes of recent clinical trials. Finally, we will propose a strategy to address the management of POR.

Expert commentary: Anti-tumor necrosis factor (Anti-TNF) agents are the most effective therapy to prevent POR in Crohn’s disease. Patient risk stratification and active monitoring with scheduled ileocolonoscopy are cornerstones of optimal POR management. Further studies are needed to address areas of uncertainty including timing and duration of therapy and the role of therapeutic drug monitoring in this setting.

KEYWORDS:

• Crohn’s disease
• post-operative Crohn’s disease
• biologics
• anti-TNF agents
• endoscopic scoring system

Declaration of interest

D. Sorrentino is a consultant for AbbVie, Astra, Centocor, Ferring, Giluliani SpA, Hoffman La Roche, Janssen, Schering and Plough. The authors have no other 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 apart from those disclosed.

Additional information

Funding

This paper was not funded.