PMID- 24030230 OWN - NLM STAT- MEDLINE DCOM- 20140502 LR - 20130913 IS - 1421-9875 (Electronic) IS - 0257-2753 (Linking) VI - 31 IP - 2 DP - 2013 TI - Management of postoperative recurrence of Crohn's disease. PG - 222-8 LID - 10.1159/000353374 [doi] AB - The course of Crohn's disease (CD) is unpredictable and potentially destructive. The percentage of patients requiring surgery at some stage in their disease accumulates to over 70%. After resection of the affected intestine, reappearance of CD occurs in the majority of patients. Prophylactic medical therapy to reduce the rate of postoperative recurrence has been proven to be effective, yet the incidence of recurrence remains high. Patient profiling (risk stratification) is important in this postoperative setting. High-risk patients (associated with e.g. smoking, the need of repetitive surgery and penetrating disease) require strong immunosuppressive treatment, which should be commenced immediately after surgery, when recurrent disease activity begins. Additionally, early screening endoscopy should be performed to monitor treatment effect. The efficacy of thiopurines is shown to be higher than mesalazine or imidazole antibiotics alone for preventing and ameliorating endoscopic recurrence of CD postoperatively; however, anti-tumor necrosis factors (anti-TNFs) are increasingly considered the most potent agents. In patients with a risk factor for early postoperative recurrence, the first line of treatment is 6-mercaptopurine, in combination with imidazole antibiotics if tolerated, followed by anti-TNFs. When lesions are found at colonoscopy, therapy should be upscaled. We propose a treatment algorithm to direct therapeutic management of CD postoperatively. CI - (c) 2013 S. Karger AG, Basel. FAU - van Lent, Anja U AU - van Lent AU AD - Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. FAU - D'Haens, Geert R AU - D'Haens GR LA - eng PT - Journal Article PT - Review DEP - 20130906 PL - Switzerland TA - Dig Dis JT - Digestive diseases (Basel, Switzerland) JID - 8701186 RN - 0 (Tumor Necrosis Factor-alpha) SB - IM MH - Colonoscopy MH - Crohn Disease/pathology/*prevention & control/*surgery MH - Humans MH - Inflammation/pathology MH - *Postoperative Care MH - Recurrence MH - Tumor Necrosis Factor-alpha/metabolism EDAT- 2013/09/14 06:00 MHDA- 2014/05/03 06:00 CRDT- 2013/09/14 06:00 PHST- 2013/09/14 06:00 [entrez] PHST- 2013/09/14 06:00 [pubmed] PHST- 2014/05/03 06:00 [medline] AID - 000353374 [pii] AID - 10.1159/000353374 [doi] PST - ppublish SO - Dig Dis. 2013;31(2):222-8. doi: 10.1159/000353374. Epub 2013 Sep 6.