Postoperative Crohn’s disease: prevention and treatment

El‐Hachem, Sandra; Regueiro, Miguel

doi:10.1586/egh.09.21

Cited by 13 publications

(7 citation statements)

References 66 publications

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“…Although WCE is safe and tolerable for patients, the risk of capsule retention in patients with small-bowel strictures is a major concern [9]. In addition, efforts have been made to establish a specific scoring system for WCE to assess small-bowel CD [25].…”

Section: Wireless Capsule Endoscopymentioning

confidence: 99%

“…However, there is no optimal algorithm to be validated for the management and prevention of postoperative CD. A tailored therapy based on a patient's risk profile of postoperative recurrence has been proposed by the majority of experts [8][9][10][11][12][13]. Patients with high risk of recurrence should be treated with anti-TNF agents immediately after surgery.…”

mentioning

confidence: 99%

“…Many previous publications have discussed postoperative CD management in detail [9][10][11]13,15,16,18,19]. The aim of the present review is to summarize the recent advances in the surveillance, prevention and treatment of postoperative recurrence in CD.…”

mentioning

confidence: 99%

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Management of postoperative Crohn’s disease

Yang

et al. 2014

Expert Review of Gastroenterology & Hepatology

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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.

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Section: Wireless Capsule Endoscopymentioning

confidence: 99%

mentioning

confidence: 99%

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Management of postoperative Crohn’s disease

Yang

et al. 2014

Expert Review of Gastroenterology & Hepatology

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“…As a result, at least one third of CD patients develop potentially life threatening intestinal strictures, with resulting obstructions that often necessitate surgical intervention. Despite the frequency of these stenotic strictures in CD, there are few therapeutic options, with longterm anti-inflammatory therapy often proving ineffective in preventing fibrosis (for reviews see [116][117][118]). Although stricturoplasty has shown some positive results (for review see [119], it generally provides only short-term resolution, with repeated procedures required.…”

Section: Intestinal Fibrosis: a Maladaptive Host Responsementioning

confidence: 99%

Innate Immunity and Microbes: Conversations with the Gut Leading to Intestinal Tissue Repair and Fibrosis

Gibson¹,

Montero²,

Ryz³

2009

AIAAMC

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Inflammatory bowel diseases (IBD) are thought to occur because of impaired mucosal integrity that allows enteric bacteria to leak out of the intestine, triggering maladaptive intestinal inflammation. While the exact pathogenesis of IBD is unclear, studies have recently demonstrated that bacterial activation of innate receptors not only causes inflammation, but may also play an important role in modulating intestinal epithelial barrier function, as well as intestinal epithelial cell proliferation and repair. These mucosal homeostatic mechanisms are essential in limiting as well as repairing mucosal damage. Therefore bacterial activation of the innate immune system can have both inflammatory as well as protective healing roles in the intestine. Strikingly, these findings suggest that dysregulation of these processes could be responsible for both the barrier dysfunction as well as the heightened inflammatory tone that characterize IBD. In this review we explore the current state of knowledge underlying this novel role for innate immunity in the gastrointestinal tract, and discuss the strengths and weaknesses of the chemical and infectious models used in these studies. In addition, we discuss preliminary evidence that exaggerated microbial activation of the innate immune system may cause the fibrotic responses that develop in some patients with IBD.

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“…Several medications have been studied, with variable results. Despite treatment with 5-aminosalicylates, steroids, antibiotics, and immunomodulators, 1-year endoscopic recurrence rates are as high as 60% [4]. Recent, small, postoperative anti-tumor necrosis factor-a (TNF-a) prevention studies have shown promise in preventing Crohn's disease recurrence after surgery [5][6][7].…”

Section: Introductionmentioning

confidence: 99%