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Postoperative prevention of recurrence of Crohn’s disease

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Inflammatory Bowel Disease: From Bench to Bedside

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Summary

Although the therapy of CD is primarily medical, surgery still plays an important role in its management. The high incidence of postoperative CD recurrence is, however, a major drawback. We provide a clear and practical algorithm which will help the clinician to decide when and what kind of prophylactic treatment is indicated. Strategies to prevent recurrence start with a careful selection of patients to send for surgery, based on the known risk factors of recurrence. Current evidence suggests only a moderate effect of the known active agents in the prevention of postoperative CD recurrence. Only patients at higher risk for recurrence should continue on, or be treated with, immunosuppressives (6-MP or azathioprine) after surgery. All others can be followed clinically, or alternatively should undergo an ileocolonoscopy 3–12 months after surgery. If severe endoscopic recurrence is seen, therapy is indicated to prevent the imminent clinical symptoms, or eventually a new resection. Much is anticipated from newer biological agents potentially interacting with earlier steps in the pathogenesis of recurrent CD.

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References

  1. Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990; 99: 956–63.

    PubMed  CAS  Google Scholar 

  2. Maunoury V, Mordon S, Geboes K et al. Endoscopic fluorescence imaging for the study of anastomotic recurences in Crohn’s disease: correlation with histological findings. Gastroenterology 1999; 116; A689.

    Google Scholar 

  3. Biacone L, Scopinaro F, Ierardi M et al. 99m Tc-HMPOA granulocyte scintigraphy in the early detection of postoperative asymptomatic recurrence of Crohn’s disease. Dig Dis Sci 1997; 42: 1549–56.

    Article  Google Scholar 

  4. Rutgeerts P, Geboes K, Peeters M et al. Effect of fecal stream diversion on recurrence of Crohn’s disease in the neoterminal ileum. Lancet 1991; 338: 771–4.

    Article  PubMed  CAS  Google Scholar 

  5. D’Haens G, Geboes K, Peeters M, Baert F, Penninckx F. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 1998; 114:262–7.

    Article  PubMed  CAS  Google Scholar 

  6. Fasoli R, Kettlewell MGW, Mortensen N, Jewell DP. Response to fecal challenge in defunctioned colonic Crohn’s disease: prediction of long-term response. Br J Surg 1990; 77:616–17.

    Article  PubMed  CAS  Google Scholar 

  7. Harper PH, Lee ECG, Kettlewell MGW, Bennett MK, Jewell DP. Role of fecal stream in the maintenance of Crohn’s colitis. Gut 1985; 26: 279–84.

    PubMed  CAS  Google Scholar 

  8. Rath HC, Herfarth HH, Ikeda JS et al. Normal luminal bacteria, especially Bacteroides species, mediate chronic colitis, gastritis and arthritis in HLA-B27/β2-microglobulin transgenic rats. J Clin Invest 1996; 98: 945–53.

    Article  PubMed  CAS  Google Scholar 

  9. Keighly MR, Arabi Y, Dimock F, Burdon DW, Allan RN, Alexander-Williams J Influence of inflammatory bowel disease on intestinal microflora. Gut 1978; 19: 1099–104.

    Google Scholar 

  10. Lederman E, Neut C, Desreumaux P et al. Bacterial over-growth in the neoterminal ileum after ileocolonic resection for Crohn’s disease. Gastroenterology 1997; 112: A2865.

    Google Scholar 

  11. Rutgeerts P, Peeters M, Hiele M et al. A placebo controlled trial of metronidazole for recurrence prevention of Crohn’s disease after resection of the terminal ileum. Gastroenterology 1995; 108: 1617–21.

    Article  PubMed  CAS  Google Scholar 

  12. Rutgeerts P, D’Haens G, Baert F et al. Nitroimidazol antibiotics are efficacious for prophylaxis of postoperative recurrence of Crohn’s disease: a placebo controlled trial. Gastroenterology 1999; 116: A808.

    Google Scholar 

  13. Powell JJ, Ainley CC, Mason IM et al. Characterization of inorganic microparticles in pigment cells of human gut associated lymphoid tissue. Gut 1996; 38: 390–5.

    PubMed  CAS  Google Scholar 

  14. Wyatt J, Vogelsang H, Hubl W, Waldhoer T, Lochs H. Intestinal permeability and the prediction of relapse in Crohn’s disease. Lancet. 1993; 341: 1437–9.

    Article  PubMed  CAS  Google Scholar 

  15. Klein O, Houdret N, Desreumaux P et al. Intestinal permeability is not predicitive of endoscopic recurrence in patients operated on for Crohn’s disease. Gastroenterology 1996; 112: A1096.

    Google Scholar 

  16. Desreumaux P, Brandt E, Gambiez L et al. Distinct cytokine patterns in early and chronic ileal lesions of Crohn’s disease. Gastroenterology 1997; 113: 118–26.

    Article  PubMed  CAS  Google Scholar 

  17. D’Andrea A, Ma X, Aste-Amezaga M, Paganin C, Trinchieri G. Stimulatory and inhibitory effects of interleukin-4 and IL-13 on the production of cytokines by human peripheral blood mononuclear cells: priming for IL-12 and TNF production. J Exp Med 1995; 181: 537–46.

    Article  PubMed  CAS  Google Scholar 

  18. Dubucquoi S, Janin A, Klein O et al. Activated eosinophils and interleukin 5 expression in early recurrence of Crohn’s disease. Gastroenterology 1995; 37: 242–6.

    CAS  Google Scholar 

  19. Nagel E, Bartels M, Pichlmayer R. Scanning electron-microscopic lesions in Crohn’s disease: relevance for the interpretation of postoperative recurrence. Gastroenterology 1995; 108: 376–82.

    Article  PubMed  CAS  Google Scholar 

  20. Cameron JL, Hamilton SR, Coleman J, Sitzmann JV, Bayless TM. Patterns of ileal recurrence in Crohn’s disease. Ann Surg 1992; 215: 546–51.

    Article  PubMed  CAS  Google Scholar 

  21. Geboes K, Rutgeerts P, Ectors N et al. Are section margins useful for the prediction of recurrence of Crohn’s disease after all? Gastroenterology 1990; 98: A171.

    Google Scholar 

  22. D’Haens G, Penninckx F, Rutgeerts P, Geboes K. The presence and severity of neural inflammation predict severe postoperative recurrence of Crohn’s disease. Gastroenterology 1998; 114: A963.

    Google Scholar 

  23. D’Haens G, Sels F, Pceters M, Baert F, Geboes K, Rutgeerts P. Curative ileal resection of Crohn’s disease followed by recurrence in the rectum. Digestion 1998; 59(Suppl.3):132.

    Google Scholar 

  24. Camma C, Giunta M, Roselli M, Cottonc M. Mcsalaminc in the maintenance treatment of Crohn’s disease: a metaanalysis adjusted for confouding variables. Gastroenterology 1997; 113: 1465–73.

    Article  PubMed  CAS  Google Scholar 

  25. McLcod RS, Wolff B, Steinhart H et al. Risk and significance of endoscopic/radiological evidence of recurrent Crohn’s disease. Gastroenterology 1997; 113: 1823–7.

    Article  Google Scholar 

  26. de Dombal FT, Burton I, Golighcr C. The early and late results of surgical treatment for Crohn’s disease. Br J Surg 1971; 11: 805–16.

    Article  Google Scholar 

  27. Hcimann TM, Greenstein AJ, Lewis B, Kaufman D, Heimann DM, Aufses AH. Comparison of primary and reoperative surgery in patients with Crohn’s disease. Ann Surg. 1998; 227: 492–5.

    Article  Google Scholar 

  28. D’Haens G, Baert F, Gasparaitis A, Hanauer S. Length and type of recurrent ileitis after ileal resection correlate with presurgical features in Crohn’s disease. Inflam Bowel Dis 1997; 3: 249–53.

    Article  Google Scholar 

  29. Wolff BG. Factors determining recurrence following surgery for Crohn’s disease. World J Surg. 1998; 22: 364–9.

    Article  PubMed  CAS  Google Scholar 

  30. Lautenbach E, Berlin JA, Lichtenstein GR. Risk factors for early postoperative recurrence of Crohn’s disease. Gastroenterology 1998; 115: 259–67.

    Article  PubMed  CAS  Google Scholar 

  31. Kotanagi HH, Kramer K, Fazio VW, Petras RE. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon Rectum 1991, 34:909–916.

    Article  PubMed  CAS  Google Scholar 

  32. Cottone M, Rosselli M, Orlando A et al. Smoking habits and recurrence in Crohn’s disease. Gastroenterology 1994; 106:643–8.

    PubMed  CAS  Google Scholar 

  33. Sutherland LR, Ramcharan S, Bryant H, Fick G. Effect of cigarette smoking on recurrence of Crohn’s disease. Gastroenterology. 1990; 98: 1123–8.

    PubMed  CAS  Google Scholar 

  34. Cosnes J, Carbonnel F, Carrat F, Beaugerie L, Catton S, Gendre J. Effects of current and former cigarette smoking on the clinical course of Crohn’s disease. Aliment Pharmacol Ther 1999; 13: 1403–11.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  36. Yamamoto T, Keighley MR. Smoking and disease recurrence after operation for Crohn’s disease. Br J Surg 2000; 87: 398–404.

    Article  PubMed  CAS  Google Scholar 

  37. Wolfson DM, Sachar DB, Cohen A et al. Granulomas do not affect postoperative recurrence rates in Crohn’s disease. Gastroenterology. 1982; 83: 405–9.

    PubMed  CAS  Google Scholar 

  38. Kotanagi HH, Kramer K, Fazio VW, Petras RE. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon Rectum 1991; 34: 909–16.

    Article  PubMed  CAS  Google Scholar 

  39. McLeod RS. Is it possible to prevent recurrent Crohn’s disease with medical or surgical interventions? Neth J Med 1996; 48: 68–70.

    Article  PubMed  CAS  Google Scholar 

  40. Sachar DB, Wolfson DM, Greenstein AJ, Goldberg J, Styczynski R, Janowitz HD. Risk factors for postoperative recurrence of Crohn’s disease. Gastroenterology. 1983; 85: 917–21.

    PubMed  CAS  Google Scholar 

  41. Goligher JC. The long-term results of excisional surgery for primary and recurrent Crohn’s disease of the large intestine. Dis Colon Rectum 1985; 28: 51–5.

    Article  PubMed  CAS  Google Scholar 

  42. Heimann TM, Greenstein AJ, Lewis B, Kaufman D, Heimann DM, Aufses AH. Prediction of early symptomatic recurrence after intestinal resection in Crohn’s disease. Ann Surg. 1993; 218: 294–9.

    Article  PubMed  CAS  Google Scholar 

  43. Ho I, Greenstein AJ, Bodian CA, Janowitz HD. Recurrence of Crohn’s disease in end ileostomics. Inflam Bowel Dis 1995; 1: 173–8.

    Article  Google Scholar 

  44. Aeberhard P, Berchtold W, Ricdtmann HJ, Stadclmann G. Surgical recurrence of perforating and nonperforating Crohn’s disease. Dis Colon Rectum 1996; 39: 80–7.

    Article  PubMed  CAS  Google Scholar 

  45. Caprilli R, Andreoli A, Capurso L et al. and the GISC. Oral mcsala/inc (Asacol) for the prevention of postoperative recurrence of Crohn’s disease. Eur J Gastrocnterol Hepatol 1994; 8: 35–43.

    CAS  Google Scholar 

  46. Brignola C, Cottone M, Pera A et al. and the Italian Cooperative Study Group. Mesalamine in the prevention of endoscopic recurrence after intestinal resection for Crohn’s disease. Gastroenterology 1995; 108: 345–9.

    Article  PubMed  CAS  Google Scholar 

  47. McLeod RS, Wolff BG, Steinhart AH et al. Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease. Gastroenterology 1995; 109: 404–13.

    Article  PubMed  CAS  Google Scholar 

  48. Lochs H, Mayer M, Fleig WE, Mortensen PB, Bauer P and ECCDS Study Group IV. Prophylaxis of postoperative relapse in Crohn’s disease with mesalazine: European Cooperative Crohn’s Disease Study VI. Gastroenterology 2000; 118: 264–73.

    Article  PubMed  CAS  Google Scholar 

  49. Willoughby J.M., Beckett J, Kumar P.J., Dawson AM. Controlled trial of azathioprine in Crohn’s disease. Lancet 1971; 2: 944–7.

    Article  PubMed  CAS  Google Scholar 

  50. Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS. Treatment of Crohn’s disease with 6-mercaptopurine. A long-term randomized double-blind study. N Engl J Med 1980, 302: 981–987.

    Article  PubMed  CAS  Google Scholar 

  51. Korelitz B, Hanauer S, Rutgeerts P, Present D, Peppercorn M. Postoperative prophylaxis with 6-MP, 5-ASA or placebo in Crohn’s disease: a two year multicenter trial. Gastroenterology 1998; 114: A1011.

    Article  Google Scholar 

  52. Kader HA, Raynor SC, Young R et al. Introduction of 6-mercaptopurine in Crohn’s disease patients during the perioperative period: a preliminary evaluation evaluation of recurrence of disease. J Pediatr Gastoenterol Nutri 1997; 25: 93–7.

    Article  CAS  Google Scholar 

  53. Colombel JF, Rutgeerts P, Malchow H et al. Safety and tolerance of subcutaneous recombinant human interleukin-10 in subjects with Crohn’s disease after first ileal or ileocolonic resection. Gastroenterology 1998; 114: A1011.

    Google Scholar 

  54. Hellers G, Cortot A, Jewell D et al. (IOIBD Budesonide Study Group). Oral budesonide for prevention of postsurgical recurrence in Crohn’s disease. Gastroenterology 1999, 116: 294–300.

    Article  PubMed  CAS  Google Scholar 

  55. Ewe K, Böttger T, Buhr HJ, Ecker KW, Otto HF. Low dose budesonide treatment for prevention of postoperative recurrence of Crohn’s disease: a multicentre randomized placebo controlled trial. Eur J Gastroenterol Hepatol. 1999; 11: 277–82.

    Article  PubMed  CAS  Google Scholar 

  56. Raedler A, Peters I, Screiber S. Treatment with azathioprine and budesonide prevents reccurence of ileocolonic stenosis after endoscopic dilatation in Crohn’s disease. Gastroenterology 1997, 112: A1067.

    Google Scholar 

  57. D’Haens G, Geboes K, Ponette E et al. Healing of severe recurrent ileitis with azathioprine therapy in patients with Crohn’s disease. Gastroenterology 1997, 112: 1475–81.

    Article  PubMed  CAS  Google Scholar 

  58. Frieri G, Pimpo MT, Andreoli A et al. Prevention of postoperative recurrence of Crohn’s disease requires adequate mucosal concentration of mesalazine. Aliment Pharmacol Ther 1999; 13: 577–82.

    Article  PubMed  CAS  Google Scholar 

  59. Van Montfrans C, te Velde A, Spts H, Hooijberg E, van Deventer S. Therapeutic potential of genetically modified T-lymphocytes in Crohn’s disease. Gastroenterology 2000; 118:A873.

    Google Scholar 

  60. Campieri M, Rizello F, Venturi A et al. Combination of antibiotic and probiotic treatment is efficacious in prophylaxis of postoperative recurrence of Crohn’s disease: a randomized controlled study versus mesalamine. Gastroenterology 2000; 118: A781.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Heilig Hartziekenhuis Roeselare Belgium, University Hospital Leuven, Belgium

    Filip Baert (IBD Consultant)

  2. Gastroenterologist, Imelda General Hospital, Bonheiden and University Hospital Leuven, Leuven, Belgium

    Geert D’Haens

  3. Department of Gastroenterology, University Hospital of Gasthuisberg, 3000, Leuven, Belgium

    Paul Rutgeerts (Professor of Medicine)

Authors
  1. Filip Baert
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  2. Geert D’Haens
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  3. Paul Rutgeerts
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Editor information

Editors and Affiliations

  1. Cedars-Sinai IBD Center, Los Angeles, CA, USA

    Stephan R. Targan  & Loren C. Karp  & 

  2. Cork University Hospital, Cork, Ireland

    Fergus Shanahan

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© 2003 Kluwer Academic Publishers

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Baert, F., D’Haens, G., Rutgeerts, P. (2003). Postoperative prevention of recurrence of Crohn’s disease. In: Targan, S.R., Shanahan, F., Karp, L.C. (eds) Inflammatory Bowel Disease: From Bench to Bedside. Springer, Boston, MA. https://doi.org/10.1007/0-387-25808-6_35

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  • DOI: https://doi.org/10.1007/0-387-25808-6_35

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-25807-2

  • Online ISBN: 978-0-387-25808-9

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