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World J Gastroenterol. Jul 21, 2011; 17(27): 3213-3219
Published online Jul 21, 2011. doi: 10.3748/wjg.v17.i27.3213
Risk of postoperative recurrence and postoperative management of Crohn’s disease
Antonino Spinelli, Matteo Sacchi, Gionata Fiorino, Silvio Danese, Marco Montorsi
Antonino Spinelli, Matteo Sacchi, Marco Montorsi, Department and Chair of General Surgery, University of Milan, Istituto Clinico Humanitas IRCCS, Via Manzoni 5620089, Rozzano, Milan, Italy
Gionata Fiorino, Silvio Danese, IBD Unit, Department of Gastroenterology, Istituto Clinico Humanitas IRCCS, Via Manzoni 5620089, Rozzano, Milan, Italy
Author contributions: Spinelli A drafted the manuscript; Sacchi M and Fiorino G performed the literature research and contributed to drafting the manuscript; Danese S and Montorsi M critically revised the paper for important intellectual content.
Correspondence to: Antonino Spinelli, MD, PhD, Department and Chair of General Surgery, University of Milan, Istituto Clinico Humanitas-IRCCS, Via Manzoni 5620089, Rozzano, Milan, Italy. antonino.spinelli@humanitas.it
Telephone: +39-2-82244772 Fax: +39-2-82244590
Received: August 14, 2010
Revised: November 12, 2010
Accepted: November 19, 2010
Published online: July 21, 2011
Abstract

Crohn’s disease (CD) is a chronic inflammatory disease of the digestive tract with systemic manifestations. Etiology is unknown, even if immunological, genetic and environmental factors are involved. The majority of CD patients require surgery during their lifetime due to progressive bowel damage, but, even when all macroscopic lesions have been removed by surgery, the disease recurs in most cases. Postoperative management represents therefore a crucial mean for preventing recurrence. Several drugs and approaches have been proposed to achieve this aim. Endoscopic inspection of the ileocolic anastomosis within 1 year from surgery is widely encouraged, given that endoscopic recurrence is one of the greatest predictors for clinical recurrence. A strategy should be planned only after stratifying patients according to their individual risk of recurrence, avoiding unnecessary therapies when possible benefits are reduced, and selecting high-risk patients for more aggressive intervention.

Keywords: Crohn’s disease; Recurrence; Postoperative treatment; Surgery; Surveillance