Preventing postoperative recurrence of Crohn disease in adults
After surgery (eg ileocaecectomy), Crohn disease predictably recurs at or proximal to the surgical anastomosis. Patients at high risk of earlier postoperative recurrence are those who:
- smoke
- have perforating disease (abscesses or fistulas, or free perforation)
- have had a prior resection.
To reduce the risk of recurrence, all patients should be counselled to stop smoking (see Smoking cessation), and most patients will benefit from drug therapy.
Patients without any of the above risk factors can be treated with 3 months of metronidazole.
Patients with one or more risk factors can be treated with 3 months of metronidazole in addition to long-term therapy with a thiopurine (azathioprine or mercaptopurine), a tumour necrosis factor (TNF) inhibitor (infliximab or adalimumab) or a combination of a thiopurine and a TNF inhibitor. TNF inhibitors are the most effective postoperative prophylaxis, although data are emerging on the effectiveness of other biological therapiesBattat, 2021.
Colonoscopy should be performed 6 months after surgery to inform further treatment decisions based on endoscopic evidence of recurrence.