Postoperative Crohn’s disease recurrence: A practical approach

Table 1 Clinical parameters that may influence the development of postoperative recurrence

Age (at onset of disease)

Gender

Family history of CD

Smoking

Duration of disease before surgery

Location

Genetic factors

Involvement of disease at the resection margin

Indication for surgery

Length of resected bowel

Anastomotic technique

Histological findings

Table 2 Characteristics of available preventive measures of post-operative recurrence

Preventive measure	Pros	Cons
Smoking cessation	Many colateral beneficial effects	Lack of specifically designed prospective studies and RCTs (data coming from retrospective studies)
	Synergistic effect with thiopurines?	Low adherence
Enteral nutrition	Excellent safety profile	Preliminary results
		Adherence?
5ASA compounds	Safety profile	Marginal benefit (high number needed to treat –NNT-)
Nitroimidazolic antibiotics	Proven efficacy in RCTs	High rate of intolerance/side effects (not applicable in a long-term basis)
Thiopurines	Strong positive results in open and retrospective studies	Safety profile/intolerance
	Proven efficacy in RCT when combined with metronidazole	Efficacy in monotherapy not conclusive (RCTs)
	Particularly efficient after second resection?
	Synergistic effect with smoking cessation?