Postoperative Approach for Crohn's Disease: The Right Therapy to the Right Patient

Abstract

No fixed strategy is recommended after surgical resections in CD. Thus, the need for a personalized approach for each patient is emphasized, in accordance with several conditions and variables.

Factors affecting the incidence of early endoscopic recurrence after ileocolonic resection for Crohn's disease: a multicentre observational study

“…Nevertheless, this was not the main objective of the current analysis, which aimed only to identify possible risk factors for recurrence. Several clinical parameters have been identified as significant risk factors for EPER or clinical recurrence after surgery for CD: smoking, prior intestinal resection, penetrating phenotype, perianal disease and extensive small bowel resection (> 50 cm) [3,4,6,8,12,15]. In the current study, all these factors previously cited were not significant in increasing EPER rates after ileocolonic resection, in univariate and multivariate analysis.…”

“…A prophylactic strategy with different types of medical therapy to prevent recurrence has been shown to be effective in several studies [3,[8][9][10]. However, recurrence rates remain significant in real world data, demanding that a better risk stratification of patients be defined [11][12][13].…”

Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease

“…60 ECCO guidelines state that prophylactic treatment with thiopurines or anti-TNF therapy is recommended after ileocolonic resection in patients with at least one risk factor for recurrence (ECCO Statement 8G). 16 Although there is no consensus on all the risk factors for early postoperative recurrence, it is generally agreed that previous surgery, extensive resection, penetrating disease, ileocolonic distribution, perianal involvement, young age at onset, and smoking all portend relatively poor prognosis.…”

Value of cross-sectional imaging in assessing active Crohn’s disease before stoma reversal

“…Medical strategy: Therapeutic management was different, regarding presence (n=20) or absence (n=18) of radiologically active CD before considering stoma reversal (p=0.01). (Table 3) In the 18 patients without active CD, 12 patients (66.7%) began an immunosuppressive therapy or TNF antagonists (according to recommendations of postoperative prevention of recurrence [16], [14], [18], [17], [15]) after performing the stoma reversal; only one patient (5.6%) began treatment before, due to rheumatological indication.…”