Review article: can post-operative recurrence in Crohn's disease be prevented?

The decision regarding prophylactic treatment after surgery in Crohn's disease (CD) requires a good estimation of the risk of recurrence. It is also important to consider the consequences of recurrence for the patient, and the risks and benefits of treatment, bearing in mind that it will be given over a long period. Several drugs have been tried to decrease the risk of recurrence. Corticosteroids and budesonide have proved to be ineffective. Mesalazine has significant efficacy in some, but not all trials, and a meta-analysis has established that it decreases the absolute risk by 10-15% after 1-2 years. Mercaptopurine seemed to be effective in a recent study. Metronidazole and ornidazole have significant efficacy, but cannot be tolerated for long periods. Probiotics represent a new approach, but evidence for their efficacy in CD is still lacking. In the past, the strategy was to give no treatment until clinical recurrence. Another approach is to give no treatment, and then to treat the patient according to severity of endoscopic recurrence. Alternative strategies include treating all patients with mesalazine until either severe endoscopic or clinical recurrence occurs, and then to use azathioprine/mercaptopurine, or to give azathioprine/mercaptopurine immediately, especially in high-risk patients.