Tailored Medical Management of the Complex Postoperative Crohn's Disease Patient

Abstract

Despite advancements in medical therapy, many patients with Crohn's disease continue to require surgery for intestinal resection and/or management of perianal disease at some point in their disease course. Unfortunately, in this complex group of patients, postoperative disease recurrence rates are high. Medical prophylaxis can be used to prevent Crohn's disease recurrence or manage residual disease after surgery, but the ideal timing to start medications after surgery varies based on patient risk factors and patient preference for medication use. Currently, the largest medical treatment effects are seen with thiopurines and antitumor necrosis factor antibodies, but there are continually expanding options as new medical therapies are developed. A proposed algorithm stratified based on patient risk factors is provided.

Value of the Prognostic Nutritional Index in Surgery for Crohn Disease in China and the Effects on Outcome: A Retrospective Study

“…Furthermore, smoking was associated with endoscopic, clinical, and surgical recurrence. Achkar et al reported that perianal lesions, smoking, internal fistula, perforation, and abdominal abscess were all independent risk factors 33. However, the present study did not indicate that smoking and perianal lesions are independent risk factors; that may be because patients in this study were generally young, highly educated, and less likely to smoke than in other countries.…”

“…Achkar et al reported that perianal lesions, smoking, internal fistula, perforation, and abdominal abscess were all independent risk factors. 33 However, the present study did not indicate that smoking and perianal lesions are independent risk factors; that may be because patients in this study were generally young, highly educated, and less likely to smoke than in other countries. In addition, some patients do not pay attention to perianal diseases and treat them as ordinary hemorrhoids, and so this factor remains to be elucidated in future research.…”

It Is All in the Fine Print: A Call for a Histopathology Checklist for IBD

“…Such tools include smoking status, disease phenotype, and surgical history. 2,6 Factors such as surgical anastomosis type and length of bowel resected are less well-replicated, often limited by heterogeneity between cohorts or small sample sizes. In this issue of the Journal, Tandon et al 7 present a rigorous metaanalysis examining the role of histologic features in predicting postoperative recurrence in CD.…”