Postoperative Management of Crohn’s Disease: What Can We Do to Prevent Recurrence?

Adriana Georgiana Olariu, Liliana Bordeianou


Crohn’s disease (CD) is a chronic inflammatory bowel disease with a relapsing, remitting course.  Approximately one in four CD patients requires surgery within five years of diagnosis. Unfortunately, surgery is rarely curative and up to 70% of CD patients experience endoscopic recurrence and 40% have clinical disease recurrence within 18 months after surgery.


This review is aimed at providing internists and gastroenterologists a foundation for the management of patients who underwent ileocecal resection for CD. We provide an overview of the current definitions of postoperative recurrence and prognostic factors for postoperative CD recurrence. As recent studies raised concerns about the value of these factors, we examine the evidence behind the current risk stratification algorithm and pharmacologic treatment recommendations. Lastly, we discuss future directions for research.


crohn's disease postoperative recurrence review

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Crohn BB, Ginzburg L, Oppenheimer GD. Landmark article Oct 15, 1932. Regional ileitis. A pathological and clinical entity. By Burril B. Crohn, Leon Ginzburg, and Gordon D. Oppenheimer. JAMA. 1984 Jan 6;251(1):73-9. PubMed PMID: 6361290.

Lichtenstein GR, Hanauer SB, Sandborn WJ; Practice Parameters Committee of American College of Gastroenterology. Management of Crohn's disease in adults. Am J Gastroenterol. 2009 Feb;104(2):465-83; quiz 464, 484. doi: 10.1038/ajg.2008.168. Epub 2009 Jan 6. PubMed PMID: 19174807.

Ng SC, Leung WK, Shi HY, Li MK, Leung CM, Ng CK, Lo FH, Hui YT, Tsang SW, Chan YK, Loo CK, Chan KH, Hui AJ, Chow WH, Harbord M, Ching JY, Lee M, Chan V, Tang W, Hung IF, Ho J, Lao WC, Wong MT, Sze SF, Shan EH, Lam BC, Tong RW, Mak LY, Wong SH, Wu JC, Chan FK, Sung JJ. Epidemiology of Inflammatory Bowel Disease from 1981 to 2014: Results from a Territory-Wide Population-Based Registry in Hong Kong. Inflamm Bowel Dis. 2016 Aug;22(8):1954-60. doi: 10.1097/MIB.0000000000000846. PubMed PMID: 27416041.

De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, Liew D, Prideaux L, Lawrance IC, Andrews JM, Bampton PA, Gibson PR, Sparrow M, Leong RW, Florin TH, Gearry RB, Radford-Smith G, Macrae FA, Debinski H, Selby W, Kronborg I, Johnston MJ, Woods R, Elliott PR, Bell SJ, Brown SJ, Connell WR, Desmond PV. Crohn's disease management after intestinal resection: a randomised trial. Lancet. 2015 Apr 11;385(9976):1406-17. doi: 10.1016/S0140-6736(14)61908-5. Epub 2014 Dec 24. PubMed PMID: 25542620

Wright EK, Kamm MA, De Cruz P, et al. Effect of intestinal resection on quality of life in Crohn's disease. J Crohns Colitis. 2015 Jun;9(6):452-62. PubMed PMID: 25855073.

D’Haens G, Geboes K, Peeters M, et al. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 1998;114:262–267

Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, Harrison J, Plevy SE. Infliximab prevents Crohn's disease recurrence after ileal resection. Gastroenterology. 2009 Feb;136(2):441-50.e1; quiz 716. doi: 10.1053/j.gastro.2008.10.051. Epub 2008 Oct 31. PubMed PMID: 19109962.

Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology. 1990 Oct;99(4):956-63. PubMed PMID: 2394349.

Regueiro M, Kip KE, Baidoo L, et al. Postoperative therapy with infliximab prevents long-term Crohn’s disease recurrence. Clin Gastroenterol Hepatol 2014;12:1494–1502.

Daperno M, Comberlato M, Bossa F, Biancone L, Bonanomi AG, Cassinotti A, Cosintino R, Lombardi G, Mangiarotti R, Papa A, Pica R, Rizzello F, D'Incà R, Orlando A. Inter-observer agreement in endoscopic scoring systems: preliminary report of an ongoing study from the Italian Group for Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis. 2014 Nov;46(11):969-73. doi: 10.1016/j.dld.2014.07.010. Epub 2014 Aug 19. PubMed PMID: 25154049.

Mary JY, Modigliani R. Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicentre study. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut. 1989 Jul;30(7):983-9. PubMed PMID: 2668130; PubMed Central PMCID: PMC1434265.

Daperno M, D'Haens G, Van Assche G, Baert F, Bulois P, Maunoury V, Sostegni R, Rocca R, Pera A, Gevers A, Mary JY, Colombel JF, Rutgeerts P. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc. 2004 Oct;60(4):505-12. PubMed PMID: 15472670.

Khanna R, Zou G, D'Haens G, Rutgeerts P, McDonald JW, Daperno M, Feagan BG, Sandborn WJ, Dubcenco E, Stitt L, Vandervoort MK, Donner A, Luo A, Levesque BG. Reliability among central readers in the evaluation of endoscopic findings from patients with Crohn's disease. Gut. 2016 Jul;65(7):1119-25. doi: 10.1136/gutjnl-2014-308973. Epub 2015 May 2. PubMed PMID: 25935574.

Harvey RF, Bradshaw JM. A simple index of Crohn's-disease activity. Lancet. 1980 Mar 8;1(8167):514. PubMed PMID: 6102236.

Best WR, Becktel JM, Singleton JW, Kern F Jr (March 1976). "Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study".Gastroenterology. 70 (3): 439–444. PMID 1248701.

Walters TD, Steinhart AH, Bernstein CN, Tremaine W, McKenzie M, Wolff BG, McLeod RS. Validating Crohn's disease activity indices for use in assessing postoperative recurrence. Inflamm Bowel Dis. 2011 Jul;17(7):1547-56. doi: 10.1002/ibd.21524. Epub 2010 Nov 15. PubMed PMID: 21674711.

AGA perspective.

Regueiro M, Feagan BG, Zou B, Johanns J, Blank MA, Chevrier M, Plevy S, Popp J, Cornillie FJ, Lukas M, Danese S, Gionchetti P, Hanauer SB, Reinisch W, Sandborn WJ, Sorrentino D, Rutgeerts P; PREVENT Study Group. Infliximab Reduces Endoscopic, but Not Clinical, Recurrence of Crohn's Disease After Ileocolonic Resection. Gastroenterology. 2016 Jun;150(7):1568-78. doi: 10.1053/j.gastro.2016.02.072. Epub 2016 Mar 3. PubMed PMID: 26946343.

Watanabe K, Sasaki I, Fukushima K, et al. Long-term incidence and characteristics of intestinal failure in Crohn’s disease: A multicenter study. J Gastroenterol. 2013:1-8.

Sutherland LR, Ramcharan S, Bryant H, Fick G. Effect of cigarette smoking on recurrence of Crohn's disease. Gastroenterology 1990; 98(5 Pt 1): 1123-8.

Yamamoto T, Keighley MR. The association of cigarette smoking with a high risk of recurrence after ileocolonic resection for ileocecal Crohn's disease. Surg Today 1999; 29: 579–80.

Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T, Tekkis PP. The effect of smoking after surgery for Crohn's disease: a meta-analysis of observational studies. Int J Colorectal Dis 2008; 23: 1213–21.

Buisson A, Chevaux JB, Bommelaer G, Peyrin-Biroulet L. Diagnosis, prevention and treatment of postoperative Crohn's disease recurrence. Dig Liver Dis. 2012 Jun;44(6):453-60. doi: 10.1016/j.dld.2011.12.018. Epub 2012 Jan 20. Review. PubMed PMID: 22265329.

Moss AC. Prevention of postoperative recurrence of Crohn's disease: what does the evidence support? Inflamm Bowel Dis. 2013 Mar-Apr;19(4):856-9. doi: 10.1097/MIB.0b013e3182802c21. Review. PubMed PMID: 23446339.

Decousus S, Boucher AL, Joubert J, Pereira B, Dubois A, Goutorbe F, Déchelotte PJ, Bommelaer G, Buisson A. Myenteric plexitis is a risk factor for endoscopic and clinical postoperative recurrence after ileocolonic resection in Crohn's disease. Dig Liver Dis. 2016 Jul;48(7):753-8. doi: 10.1016/j.dld.2016.02.023. Epub 2016 Mar 3. PubMed PMID: 27005857.

Ananthakrishnan AN. Surgery for Crohn's disease: look harder, act faster. Lancet. 2015 Apr 11;385(9976):1370-1. doi: 10.1016/S0140-6736(14)62117-6. Epub 2014 Dec 24. PubMed PMID: 25542619.

Singh S, Garg SK, Pardi DS, Wang Z, Murad MH, Loftus EV Jr. Comparative efficacy of pharmacologic interventions in preventing relapse of Crohn's disease after surgery: a systematic review and network meta-analysis. Gastroenterology. 2015 Jan;148(1):64-76.e2; quiz e14. doi: 10.1053/j.gastro.2014.09.031. Epub 2014 Sep 26. Review. PubMed PMID: 25263803; PubMed Central PMCID: PMC4274207.

Carla-Moreau A, Paul S, Roblin X, Genin C, Peyrin-Biroulet L. Prevention and treatment of postoperative Crohn's disease recurrence with anti-TNF therapy: a meta-analysis of controlled trials. Dig Liver Dis. 2015 Mar;47(3):191-6. doi: 10.1016/j.dld.2014.11.005. Epub 2014 Nov 14. Review. PubMed PMID: 25488057.

Zhao Y, Ma T, Chen YF, He XY, Ren LH, Chen J, Fang L, Su JW, Zhang HJ, Shi RH.Biologics for the prevention of postoperative Crohn's disease recurrence: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2015 Oct;39(5):637-49. doi: 10.1016/j.clinre.2015.03.007. Epub 2015 May 7. Review.PubMed PMID: 25958300.

Bordeianou L, Stein SL, Ho VP, Dursun A, Sands BE, Korzenik JR, Hodin RA. Immediate versus tailored prophylaxis to prevent symptomatic recurrences after surgery for ileocecal Crohn's disease? Surgery. 2011 Jan;149(1):72-8. doi: 10.1016/j.surg.2010.03.009. PubMed PMID: 20434748.



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