State-of-the-art medical prevention of postoperative recurrence of Crohn's disease

Abstract

Postoperative recurrence of Crohn's disease is a frequent and often severe sequela of the disease. Until a few years ago it was deemed inescapable, as all the conventional medications used to treat the disease have been proven of little benefit in preventing recurrence after surgical treatment. In the past few years, anti-TNF agents given immediately after surgery have shown a remarkable efficacy in the prevention of disease recurrence. Large, randomized, controlled trials are currently underway to confirm these findings. Anti-TNF treatment of endoscopic lesions that occur after surgery seems to be less effective than using TNF antagonists to prevent recurrence. However, although the data are limited, this treatment strategy seems to be still superior to all the other prevention strategies that are not based on anti-TNF agents. Limited data are available on long-term outcomes of patients treated with anti-TNF agents after surgery. They suggest that these medications are safe and effective after many years of treatment. In addition, these agents might prevent recurrence even at doses lower than those used in patients with Crohn's disease who have not had surgery.

LRRK2 but not ATG16L1 is associated with Paneth cell defect in Japanese Crohn’s disease patients

“…Type I Paneth cell phenotype was associated with poor clinical outcome in Japanese CD. To determine whether Paneth cell phenotype also correlated with clinical outcome in patients undergoing resections in Japanese CD, we analyzed the clinical outcome only for those patients who had received postoperative prophylactic therapy, as postoperative prophylaxis has been shown to be associated with outcome (26). We listed the characteristics of the patients that were included for outcome analysis in Supplemental Table 1.…”

Presence of Granulomas in Mesenteric Lymph Nodes Is Associated with Postoperative Recurrence in Crohnʼs Disease

“…[8][9][10][11][12][13] The identification of risk factors for postoperative disease recurrence may help for decision-making, prevention, and early intervention. 5,7,10,11 Purported risk factors for postoperative recurrence include the young age at diagnosis, 6,14 smoking, 6,15,16 history of surgical resection, 6,17 genetic mutations, 6,18 perforating disease type, 6,19 extensive ileal resection, 2,20 disease location, 6,21 and short disease duration from the diagnosis to the first surgery. 6,15,22 In addition, the presence of family history of inflammatory bowel disease (IBD) and active smoking at the time of the index ileocolonic resection (ICR) are associated with an increased risk of the second ICR.…”

“…Ninety-nine patients (46.9%) were male, and the mean age at the time of surgery was 25 5. 6 12.3 years.…”

“…A majority of patients will develop disease recurrence after bowel resection 4 with a substantial number of them becoming symptomatic and eventually requiring repeat surgeries. 5,6 The prevention, disease monitoring, and management of postoperative recurrence of CD have been challenging. 7 The pathophysiology of recurrence is poorly understood.…”

Surgery for Crohn’s disease and anti-TNF agents: the changing scenario

“…Traditional medications for this indication including steroids, immunomodulators, aminosalicylates, antibiotics and probiotics have shown, at best, modest efficacy with a benefit in 10-20% of patients for prevention of clinical recurrence [49][50][51]. Indeed, the lack of effective medications for a long time has generated a widespread conviction, especially among surgeons, that such complication is almost unavoidable [52].…”