Skip to main content

Advertisement

SpringerLink
Log in

Clinical Update on the Prevention and Management of Postoperative Crohn’s Disease Recurrence

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Despite advances in therapeutics, a significant portion of patients with Crohn’s disease still require surgical management. In this article, we present updates to the natural history, prognostication and postoperative monitoring, and novel therapeutics in the prevention and treatment of postoperative Crohn’s disease recurrence.

Recent Findings

Clinical risk factors have been associated with higher rates of postoperative recurrence (POR), and in recent studies demonstrate an increased cumulative risk with presence of additional risk factors. Additional novel clinical, histologic, and “-omic” risk factors for recurrence have recently been elucidated, including the role of the mesentery on recurrence and perioperative intraabdominal septic complications. High-risk patients benefit most from medical prophylaxis, including anti-TNF with or without immunomodulator therapy to prevent recurrence. New biologics such as vedolizumab and ustekinumab have emerging evidence in the use of prophylaxis, especially with recent REPREVIO trial data. Non-invasive disease monitoring, such as cross-sectional enterography, intestinal ultrasound, and fecal calprotectin, have been validated against ileocolonoscopy.

Summary

Recent advances in the prediction, prevention, and monitoring algorithms of postoperative Crohn’s disease may be leading to a reduction in postoperative recurrence. Ongoing trials will help determine optimal monitoring and management strategies for this at-risk population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Frolkis AD, Dykeman J, Negrón ME, Debruyn J, Jette N, Fiest KM, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology. 2013;145:996–1006.

    Article  PubMed  Google Scholar 

  2. Frolkis AD, Lipton DS, Fiest KM, Negrón ME, Dykeman J, deBruyn J, et al. Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol. 2014;109:1739–48.

    Article  PubMed  Google Scholar 

  3. Tsai L, Ma C, Dulai PS, Prokop LJ, Eisenstein S, Ramamoorthy SL, et al. Contemporary risk of surgery in patients with ulcerative colitis and Crohn’s disease: a meta-analysis of population-based cohorts. Clin Gastroenterol Hepatol. 2021;19:2031-2045.e11.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Hu JH, Shah RS, Bachour SP, Joesph A, Pothula S, Vinaithirthan V, Li T, Syed H, Hajj Ali A, Contreras S, Regueiro M, Holubar S, Axelrad J, Barnes E, Click B, Cohen B. Histologic activity despite endoscopic remission predicts Crohn’s disease recurrence following ileocolonic resection. Gastroenterology. 2023;164:S-890.

    Article  Google Scholar 

  6. Olaison G, Smedh K, Sjödahl R. Natural course of Crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut. 1992;33:331–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G. Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut. 1984;25:665–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Swoger JM, Regueiro M. Evaluation for postoperative recurrence of crohn disease. Gastroenterol Clin North Am. 2012;41:303–14.

    Article  PubMed  Google Scholar 

  9. Sachar DB. The problem of postoperative recurrence of Crohn’s disease. Med Clin North Am. 1990;74:183–8.

    Article  CAS  PubMed  Google Scholar 

  10. Fortinsky KJ, Kevans D, Qiang J, Xu W, Bellolio F, Steinhart H, et al. Rates and predictors of endoscopic and clinical recurrence after primary ileocolic resection for Crohn’s disease. Dig Dis Sci. 2017;62:188–96.

    Article  PubMed  Google Scholar 

  11. Joustra V, Duijvestein M, Mookhoek A, Bemelman W, Buskens C, Koželj M, et al. Natural history and risk stratification of recurrent Crohn’s disease after ileocolonic resection: a multicenter retrospective cohort study. Inflamm Bowel Dis. 2022;28:1–8.

    Article  PubMed  Google Scholar 

  12. Cañete F, Mañosa M, Casanova MJ, González-Sueyro RC, Barrio J, Bermejo F, et al. Adalimumab or infliximab for the prevention of early postoperative recurrence of crohn disease: results from the ENEIDA registry. Inflamm Bowel Dis. 2019;25:1862–70.

    Article  PubMed  Google Scholar 

  13. Mañosa M, Fernández-Clotet A, Nos P, Martín-Arranz MD, Manceñido N, Carbajo A, et al. Ustekinumab and vedolizumab for the prevention of postoperative recurrence of Crohn’s disease: results from the ENEIDA registry. Dig Liver Dis. 2023;55:46–52.

    Article  PubMed  Google Scholar 

  14. Cruz PD, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet. 2015;385:1406–17.

    Article  PubMed  Google Scholar 

  15. Armuzzi A, Felice C, Papa A, Marzo M, Pugliese D, Andrisani G, et al. Prevention of postoperative recurrence with azathioprine or infliximab in patients with Crohn’s disease: an open-label pilot study. J Crohns Colitis. 2013;7:e623-629.

    Article  PubMed  Google Scholar 

  16. Regueiro M, Feagan BG, Zou B, Johanns J, Blank MA, Chevrier M, et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection. Gastroenterology. 2016;150:1568–78.

    Article  CAS  PubMed  Google Scholar 

  17. Ollech JE, Aharoni-Golan M, Weisshof R, Normatov I, Sapp AR, Kalakonda A, et al. Differential risk of disease progression between isolated anastomotic ulcers and mild ileal recurrence after ileocolonic resection in patients with Crohn’s disease. Gastrointest Endosc. 2019;90:269–75.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bachour SP, Shah RS, Lyu R, Rieder F, Qazi T, Lashner B, et al. Mild neoterminal ileal post-operative recurrence of Crohn’s disease conveys higher risk for severe endoscopic disease progression than isolated anastomotic lesions. Aliment Pharmacol Ther. 2022;55:1139–50.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hammoudi N, Auzolle C, Tran Minh M-L, Boschetti G, Bezault M, Buisson A, et al. Postoperative endoscopic recurrence on the neoterminal ileum but not on the anastomosis is mainly driving long-term outcomes in Crohn’s disease. Off J Am Coll Gastroenterol ACG. 2020;115:1084–93.

    Article  Google Scholar 

  20. Rivière P, Pekow J, Hammoudi N, Wils P, De Cruz P, Wang CP, et al. Comparison of the risk of Crohn’s disease postoperative recurrence between modified rutgeerts score i2a and i2b categories: an individual patient data meta-analysis. J Crohns Colitis. 2023;17:269–76.

    Article  PubMed  Google Scholar 

  21. Hirten RP, Ungaro RC, Castaneda D, Lopatin S, Sands BE, Colombel JF, et al. Anastomotic ulcers after ileocolic resection for Crohn’s disease are common and predict recurrence. Inflamm Bowel Dis. 2020;26:1050–8.

    Article  PubMed  Google Scholar 

  22. Rivière P, Vermeire S, Irles-Depe M, Van Assche G, Rutgeerts P, de Buck van Overstraeten A, et al. No change in determining Crohn’s disease recurrence or need for endoscopic or surgical intervention with modification of the Rutgeerts’ scoring system. Clin Gastroenterol Hepatol. 2019;17:1643–5.

    Article  PubMed  Google Scholar 

  23. Kim JY, Park SH, Park JC, Noh S, Lee JS, Kim J, et al. The clinical significance of anastomotic ulcers after ileocolic resection to predict postoperative recurrence of Crohn’s disease. Dig Dis Sci. 2021;66:3132–40.

    Article  PubMed  Google Scholar 

  24. Beelen EMJ, de Vries AC, Bodelier AG, Moolenaar J, Schouten WR, van der Woude CJ. Isolated ileal blind loop inflammation after intestinal resection with ileocolonic anastomosis in Crohn’s disease: an often neglected endoscopic finding with an unfavorable outcome. Eur J Gastroenterol Hepatol. 2019;31:1370–5.

    Article  PubMed  Google Scholar 

  25. Narula N, Wong ECL, Dulai PS, Marshall JK, Jairath V, Reinisch W. The performance of the rutgeerts score, SES-CD, and MM-SES-CD for prediction of postoperative clinical recurrence in Crohn’s disease. Inflamm Bowel Dis. 2023;29:716–25.

    Article  PubMed  Google Scholar 

  26. Qiu Y, Mao R, Chen B-L, Li X-H, He Y, Zeng Z-R, et al. Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther. 2014;40:134–46.

    Article  CAS  PubMed  Google Scholar 

  27. Bruining DH, Zimmermann EM, Loftus EV, Sandborn WJ, Sauer CG, Strong SA. Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn’s disease. Radiology. 2018;286:776–99.

    Article  PubMed  Google Scholar 

  28. Choi IY, Park SH, Park SH, Yu CS, Yoon YS, Lee JL, et al. CT enterography for surveillance of anastomotic recurrence within 12 months of bowel resection in patients with Crohn’s disease: an observational study using an 8-year registry. Korean J Radiol. 2017;18:906–14.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Deepak P, Fletcher JG, Fidler JL, Bruining DH. Computed tomography and magnetic resonance enterography in Crohn’s disease: assessment of radiologic criteria and endpoints for clinical practice and trials. Inflamm Bowel Dis. 2016;22:2280–8.

    Article  PubMed  Google Scholar 

  30. Bachour SP, Shah R, Lyu R, Nakamura T, Shen M, Li T, et al. Test characteristics of cross-sectional imaging and concordance with endoscopy in postoperative Crohn’s disease. Clin Gastroenterol Hepatol. 2021;S1542–3565(21):01357–4.

    Google Scholar 

  31. Schaefer M, Laurent V, Grandmougin A, Vuitton L, Bourreille A, Luc A, et al. A magnetic resonance imaging index to predict Crohn’s disease postoperative recurrence: the MONITOR index. Clin Gastroenterol Hepatol. 2021;S1542–3565(21):00699–6.

    Google Scholar 

  32. Nehra AK, Sheedy SP, Wells ML, VanBuren WM, Hansel SL, Deepak P, et al. Imaging findings of ileal inflammation at computed tomography and magnetic resonance enterography: what do they mean when ileoscopy and biopsy are negative? J Crohns Colitis. 2020;14:455–64.

    Article  PubMed  Google Scholar 

  33. Rispo A, Imperatore N, Testa A, Nardone OM, Luglio G, Caporaso N, et al. Diagnostic accuracy of ultrasonography in the detection of postsurgical recurrence in Crohn’s disease: a systematic review with meta-analysis. Inflamm Bowel Dis. 2018;24:977–88.

    Article  PubMed  Google Scholar 

  34. Rivière P, Vermeire S, Irles-Depe M, Van Assche G, Rutgeerts P, Denost Q, et al. Rates of postoperative recurrence of Crohn’s disease and effects of immunosuppressive and biologic therapies. Clin Gastroenterol Hepatol. 2021;19:713-720.e1.

    Article  PubMed  Google Scholar 

  35. Shah RS, Click BH. Medical therapies for postoperative Crohn’s disease. Therap Adv Gastroenterol. 2021;14:1756284821993581.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Fumery M, Dulai PS, Meirick P, Farrell AM, Ramamoorthy S, Sandborn WJ, et al. Systematic review with meta-analysis: recurrence of Crohn’s disease after total colectomy with permanent ileostomy. Aliment Pharmacol Ther. 2017;45:381–90.

    Article  CAS  PubMed  Google Scholar 

  37. Jain SR, Ow ZGW, Chin YH, Lim WH, Kong G, Tham HY, et al. Quantifying the rate of recurrence of postoperative Crohn’s disease with biological therapy a meta-analysis. J Dig Dis. 2021;22:399–407.

    Article  CAS  PubMed  Google Scholar 

  38. 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.

    Article  CAS  PubMed  Google Scholar 

  39. Spinelli A, Sacchi M, Fiorino G, Danese S, Montorsi M. Risk of postoperative recurrence and postoperative management of Crohn’s disease. World J Gastroenterol. 2011;17:3213–9.

    PubMed  PubMed Central  Google Scholar 

  40. Amicone C, Marques CC, Reenaers C, Van Kemseke C, Seidel L, Louis E. Early post-operative endoscopy is associated with lower surgical recurrence of Crohn’s disease: a retrospective study of three successive cohorts. Gastroenterol Res Pract. 2022;2022:6341069.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T, Tekkis PP. The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis. 2008;23:1213–21.

    Article  PubMed  Google Scholar 

  42. Ryan WR, Allan RN, Yamamoto T, Keighley MRB. Crohn’s disease patients who quit smoking have a reduced risk of reoperation for recurrence. Am J Surg. 2004;187:219–25.

    Article  PubMed  Google Scholar 

  43. Dang JT, Dang TT, Wine E, Dicken B, Madsen K, Laffin M. The genetics of postoperative recurrence in crohn disease: a systematic review, meta-analysis, and framework for future work. Crohn’s Colitis 360. 2021;3:otaa094.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Büning C, Genschel J, Bühner S, Krüger S, Kling K, Dignass A, et al. Mutations in the NOD2/CARD15 gene in Crohn’s disease are associated with ileocecal resection and are a risk factor for reoperation. Aliment Pharmacol Ther. 2004;19:1073–8.

    Article  PubMed  Google Scholar 

  45. Auzolle C, Nancey S, Tran-Minh M-L, Buisson A, Pariente B, Stefanescu C, et al. Male gender, active smoking and previous intestinal resection are risk factors for post-operative endoscopic recurrence in Crohn’s disease: results from a prospective cohort study. Aliment Pharmacol Ther. 2018;48:924–32.

    Article  PubMed  Google Scholar 

  46. Unkart JT, Anderson L, Li E, Miller C, Yan Y, Gu CC, et al. Risk factors for surgical recurrence after ileocolic resection of Crohn’s disease. Dis Colon Rectum. 2008;51:1211–6.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Poggioli G, Laureti S, Selleri S, Brignola C, Grazi GL, Stocchi L, et al. Factors affecting recurrence in Crohn’s disease. Results of a prospective audit. Int J Colorectal Dis. 1996;11:294–8.

    Article  CAS  PubMed  Google Scholar 

  48. Yamamoto T, Allan RN, Keighley MR. Long-term outcome of surgical management for diffuse jejunoileal Crohn’s disease. Surgery. 2001;129:96–102.

    Article  CAS  PubMed  Google Scholar 

  49. 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.

    Article  CAS  PubMed  Google Scholar 

  50. Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, Lakatos PL, et al. 3rd european evidence-based consensus on the diagnosis and Management of Crohn’s disease 2016: Part 2: surgical management and special situations. J Crohns Colitis. 2017;11:135–49.

    Article  PubMed  Google Scholar 

  51. Nguyen GC, Loftus EV, Hirano I, Falck-Ytter Y, Singh S, Sultan S, et al. American Gastroenterological Association Institute guideline on the Management of Crohn’s disease after surgical resection. Gastroenterology. 2017;152:271–5.

    Article  PubMed  Google Scholar 

  52. Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1-106.

    Article  PubMed  Google Scholar 

  53. Sachar DB, Lemmer E, Ibrahim C, Edden Y, Ullman T, Ciardulo J, et al. Recurrence patterns after first resection for stricturing or penetrating Crohn’s disease. Inflamm Bowel Dis. 2009;15:1071–5.

    Article  PubMed  Google Scholar 

  54. Shah RS, Bachour SP, Joseph A, Xiao H, Lyu R, Syed H, et al. Real world surgical and endoscopic recurrence based on risk profiles and prophylaxis utilization in postoperative Crohn’s disease. Clin Gastroenterol Hepatol. 2023;S1542–3565(23):00851.

    Google Scholar 

  55. Simillis C, Yamamoto T, Reese GE, Umegae S, Matsumoto K, Darzi AW, et al. A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn’s disease. Am J Gastroenterol. 2008;103:196–205.

    Article  PubMed  Google Scholar 

  56. Bachour SP, Khan MZ, Shah RS, Joseph A, Syed H, Ali AH, et al. Anastomotic configuration and temporary diverting ileostomy do not increase risk of anastomotic stricture in postoperative Crohn’s disease. Am J Gastroenterol. 2023;118(12):2212–9. https://doi.org/10.14309/ajg.0000000000002393.

    Article  CAS  PubMed  Google Scholar 

  57. McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M. Investigators of the CAST Trial. Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2009;52:919–27.

    Article  PubMed  Google Scholar 

  58. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg. 2000;87:1697–701.

    Article  CAS  PubMed  Google Scholar 

  59. Beaugerie L, Seksik P, Nion-Larmurier I, Gendre J-P, Cosnes J. Predictors of Crohn’s disease. Gastroenterology. 2006;130:650–6.

    Article  PubMed  Google Scholar 

  60. Van Assche G, Dignass A, Reinisch W, van der Woude CJ, Sturm A, De Vos M, et al. The second european evidence-based consensus on the diagnosis and management of Crohn’s disease: special situations. J Crohns Colitis. 2010;4:63–101.

    Article  PubMed  Google Scholar 

  61. Simillis C, Purkayastha S, Yamamoto T, Strong SA, Darzi AW, Tekkis PP. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum. 2007;50:1674–87.

    Article  PubMed  Google Scholar 

  62. Click B, Merchea A, Colibaseanu DT, Regueiro M, Farraye FA, Stocchi L. Ileocolic resection for Crohn disease: the influence of different surgical techniques on perioperative outcomes, recurrence rates, and endoscopic surveillance. Inflamm Bowel Dis. 2022;28:289–98.

    Article  PubMed  Google Scholar 

  63. Gajendran M, Bauer AJ, Buchholz BM, Watson AR, Koutroubakis IE, Hashash JG, et al. Ileocecal anastomosis type significantly influences long-term functional status, quality of life, and healthcare utilization in postoperative Crohn’s disease patients independent of inflammation recurrence. Am J Gastroenterol. 2018;113:576–83.

    Article  CAS  PubMed  Google Scholar 

  64. Mao R, Kurada S, Gordon IO, Baker ME, Gandhi N, McDonald C, et al. The mesenteric fat and intestinal muscle Interface: creeping fat influencing stricture formation in Crohn’s disease. Inflamm Bowel Dis. 2019;25:421–6.

    Article  PubMed  Google Scholar 

  65. Rivera ED, Coffey JC, Walsh D, Ehrenpreis ED. The mesentery, systemic inflammation, and Crohn’s disease. Inflamm Bowel Dis. 2019;25:226–34.

    Article  PubMed  Google Scholar 

  66. Coffey CJ, Kiernan MG, Sahebally SM, Jarrar A, Burke JP, Kiely PA, et al. Inclusion of the mesentery in ileocolic resection for Crohn’s disease is associated with reduced surgical recurrence. J Crohns Colitis. 2018;12:1139–50.

    Article  PubMed  PubMed Central  Google Scholar 

  67. •• van der Does de Willebois E. OP070:Mesenteric SParIng versus extensive mesentereCtomY in primary ileocolic resection for ileocaecal Crohn’s disease (SPICY trial): Preliminary results of an international multicentre randomised controlled trial. Copenhagen, Denmark; 2023. Recently presented preliminary results from first RCT showing no difference in mesentery resection in preventing POR.

  68. van der Does de Willebois EML. Mesenteric SParIng versus extensive mesentereCtomY in primary ileocolic resection for ileocaecal Crohn’s disease (SPICY): study protocol for randomized controlled trial. BJS Open. 2022;6:zrab136.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Holubar SD, Gunter RL, Click BH, Achkar J-P, Lightner AL, Lipman JM, et al. Mesenteric excision and exclusion for ileocolic Crohn’s disease: feasibility and safety of an innovative, combined surgical approach with extended mesenteric excision and kono-S anastomosis. Dis Colon Rectum. 2022;65:e5-13.

    Article  PubMed  PubMed Central  Google Scholar 

  70. •• Luglio G, Rispo A, Imperatore N, Giglio MC, Amendola A, Tropeano FP, et al. Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn’s disease: the SuPREMe-CD Study - A randomized clinical trial. Ann Surg. 2020;272:210–7. First RCT to demonstrate decreased rates of endoscopic and clinical POR with novel Kono-S anastomosis.

    Article  PubMed  Google Scholar 

  71. Alibert L, Betton L, Falcoz A, Manceau G, Benoist S, Zerbib P, et al. Does KONO-S anastomosisreduce recurrence in Crohn’s disease compared to conventional ileocolonic anastomosis? A nationwide propensity score-matched study from GETAID Chirurgie Group (KoCoRICCO study). J Crohns Colitis. 2023;jjad176. https://doi.org/10.1093/ecco-jcc/jjad176.

  72. Ng CH, Chin YH, Lin SY, Koh JWH, Lieske B, Koh FH-X, et al. Kono-S anastomosis for Crohn’s disease: a systemic review, meta-analysis, and meta-regression. Surg Today. 2021;51:493–501.

    Article  PubMed  Google Scholar 

  73. Alshantti A, Hind D, Hancock L, Brown SR. The role of kono-S anastomosis and mesenteric resection in reducing recurrence after surgery for Crohn’s disease: a systematic review. Colorectal Dis. 2021;23:7–17.

    Article  CAS  PubMed  Google Scholar 

  74. Tyrode G, Lakkis Z, Vernerey D, Falcoz A, Clairet V, et al. KONO-S anastomosis is not superior to conventional anastomosis for the reduction of postoperative endoscopic recurrence in Crohn’s disease. Inflamm Bowel Dis. 2023;izad214. https://doi.org/10.1093/ibd/izad214.

  75. Iesalnieks I, Kilger A, Glaß H, Müller-Wille R, Klebl F, Ott C, et al. Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome. Int J Colorectal Dis. 2008;23:1167–74.

    Article  PubMed  Google Scholar 

  76. Bachour SP, Shah RS, Rieder F, Qazi T, Achkar JP, Philpott J, et al. Intra-abdominal septic complications after ileocolic resection increases risk for endoscopic and surgical postoperative Crohn’s disease recurrence. J Crohns Colitis. 2022;16:1696–705.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Bressenot A, Peyrin-Biroulet L. Histologic features predicting postoperative crohn’s disease recurrence. Inflamm Bowel Dis. 2015;21:468–75.

    Article  PubMed  Google Scholar 

  78. Kiyokawa H, Abe M, Matsui T, Kurashige M, Ohshima K, Tahara S, et al. Deep learning analysis of histologic images from intestinal specimen reveals adipocyte shrinkage and mast cell infiltration to predict postoperative Crohn disease. Am J Pathol. 2022;192:904–16.

    Article  PubMed  Google Scholar 

  79. Hammoudi N, Cazals-Hatem D, Auzolle C, Gardair C, Ngollo M, Bottois H, et al. Association between microscopic lesions at ileal resection margin and recurrence after surgery in patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2020;18:141-149.e2.

    Article  PubMed  Google Scholar 

  80. Simillis C, Jacovides M, Reese GE, Yamamoto T, Tekkis PP. Meta-analysis of the role of granulomas in the recurrence of Crohn disease. Dis Colon Rectum. 2010;53:177–85.

    Article  PubMed  Google Scholar 

  81. Ferrante M, de Hertogh G, Hlavaty T, D’Haens G, Penninckx F, D’Hoore A, et al. The value of myenteric plexitis to predict early postoperative Crohn’s disease recurrence. Gastroenterology. 2006;130:1595–606.

    Article  PubMed  Google Scholar 

  82. Nakao S, Itabashi M, Yamamoto T, Okamoto T. Predictive value of myenteric and submucosal plexitis for postoperative Crohn’s disease recurrence. J Anus Rectum Colon. 2018;1:56–64.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Sokol H, Brot L, Stefanescu C, Auzolle C, Barnich N, Buisson A, et al. Prominence of ileal mucosa-associated microbiota to predict postoperative endoscopic recurrence in Crohn’s disease. Gut. 2020;69:462–72.

    Article  CAS  PubMed  Google Scholar 

  84. Buisson A, Sokol H, Hammoudi N, Nancey S, Treton X, Nachury M, et al. Role of adherent and invasive Escherichia coli in Crohn’s disease: lessons from the postoperative recurrence model. Gut. 2023;72:39–48.

    Article  PubMed  Google Scholar 

  85. De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A, et al. Efficacy of thiopurines and adalimumab in preventing Crohn’s disease recurrence in high-risk patients - a POCER study analysis. Aliment Pharmacol Ther. 2015;42:867–79.

    Article  PubMed  Google Scholar 

  86. Li T, Click B, Bachour S, Sachs M, Barnes EL, Cohen BL, et al. Suboptimal guideline adherence and biomarker underutilization in monitoring of post-operative Crohn’s disease. Dig Dis Sci. 2023;68:3596–604.

    Article  CAS  PubMed  Google Scholar 

  87. Walters TD, Steinhart AH, Bernstein CN, Tremaine W, McKenzie M, Wolff BG, et al. Validating Crohnʼs disease activity indices for use in assessing postoperative recurrence. Inflamm Bowel Dis. 2011;17:1547–56.

    Article  CAS  PubMed  Google Scholar 

  88. Hanzel J, Jairath V, De Cruz P, Guizzetti L, Shackelton LM, Bossuyt P, et al. Recommendations for standardizing clinical trial design and endoscopic assessment in postoperative Crohn’s disease. Inflamm Bowel Dis. 2022;28:1321–31.

    Article  PubMed  Google Scholar 

  89. Furfaro F, D’Amico F, Zilli A, Craviotto V, Aratari A, Bezzio C, et al. Noninvasive assessment of postoperative disease recurrence in Crohn’s disease: a multicenter, prospective cohort study on behalf of the italian Group for Inflammatory Bowel Disease. Clin Gastroenterol Hepatol. 2022;S1542–3565(22):01131–4.

    Google Scholar 

  90. Wright EK, Kamm MA, De Cruz P, Hamilton AL, Ritchie KJ, Krejany EO, et al. Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn’s disease after surgery. Gastroenterology. 2015;148:938-947.e1.

    Article  CAS  PubMed  Google Scholar 

  91. Tham YS, Yung DE, Fay S, Yamamoto T, Ben-Horin S, Eliakim R, et al. Fecal calprotectin for detection of postoperative endoscopic recurrence in Crohn’s disease: systematic review and meta-analysis. Therap Adv Gastroenterol. 2018;11:1756284818785571.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Kopylov U, Yung DE, Engel T, Avni T, Battat R, Ben-Horin S, et al. Fecal calprotectin for the prediction of small-bowel Crohn’s disease by capsule endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2016;28:1137–44.

    Article  CAS  PubMed  Google Scholar 

  93. Ananthakrishnan AN, Adler J, Chachu KA, Nguyen NH, Siddique SM, Weiss JM, et al. AGA Clinical practice guideline on the role of biomarkers for the management of Crohn’s disease.

  94. Hamilton AL, De Cruz P, Wright EK, Dervieux T, Jain A, Kamm MA. Non-invasive serological monitoring for Crohn’s disease postoperative recurrence. J Crohns Colitis. 2022;16:1797–807.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Walshe M, Nayeri S, Ji J, Hernandez-Rocha C, Sabic K, Hu L, et al. A role for CXCR3 ligands as biomarkers of post-operative Crohn’s disease recurrence. J Crohns Colitis. 2022;16:900–10.

    Article  PubMed  Google Scholar 

  96. Keshteli AH, Tso R, Dieleman LA, Park H, Kroeker KI, Jovel J, et al. A distinctive urinary metabolomic fingerprint is linked with endoscopic postoperative disease recurrence in Crohn’s disease patients. Inflamm Bowel Dis. 2018;24:861–70.

    Article  PubMed  Google Scholar 

  97. Yung DE, Har-Noy O, Tham YS, Ben-Horin S, Eliakim R, Koulaouzidis A, et al. Capsule endoscopy, magnetic resonance enterography, and small bowel ultrasound for evaluation of postoperative recurrence in Crohn’s disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2017;24:93–100.

    Article  PubMed  Google Scholar 

  98. Mao R, Gao X, Zhu Z, Feng S, Chen B, He Y, et al. CT enterography in evaluating postoperative recurrence of Crohn’s disease after Ileocolic ResectionComplementary role to endoscopy. Inflamm Bowel Dis. 2013;19:977–82.

    Article  PubMed  Google Scholar 

  99. De Cruz P, Kamm MA, Prideaux L, Allen PB, Desmond PV. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflamm Bowel Dis. 2012;18:758–77.

    Article  PubMed  Google Scholar 

  100. Ferrante M, Pouillon L, Mañosa M, Savarino E, Allez M, Kapizioni C, Arebi N, Carvello M, Myrelid P, De Vries AC, 8th Scientific Workshop of the European Crohns and Colitis Organisation, Rivière P, Panis Y, Domènech E. Results of the eighth scientific workshop of ECCO: prevention and treatment of postoperative recurrence in patients with crohn’s disease undergoing an ileocolonic resection with ileocolonic anastomosis. J Crohns Colitis. 2023;17(11):1707–22. https://doi.org/10.1093/ecco-jcc/jjad053.

    Article  PubMed  Google Scholar 

  101. Glick LR, Sossenheimer PH, Ollech JE, Cohen RD, Hyman NH, Hurst RD, et al. Low-dose metronidazole is associated with a decreased rate of endoscopic recurrence of Crohn’s disease after ileal resection: a retrospective cohort study. J Crohns Colitis. 2019;13:1158–62.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Rutgeerts P, Hiele M, Geboes K, Peeters M, Penninckx F, Aerts R, et al. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108:1617–21.

    Article  CAS  PubMed  Google Scholar 

  103. Reinisch W, Angelberger S, Petritsch W, Shonova O, Lukas M, Bar-Meir S, et al. Azathioprine versus mesalazine for prevention of postoperative clinical recurrence in patients with Crohn’s disease with endoscopic recurrence: efficacy and safety results of a randomised, double-blind, double-dummy, multicentre trial. Gut. 2010;59:752–9.

    Article  CAS  PubMed  Google Scholar 

  104. Orlando A, Mocciaro F, Ventimiglia M, Renna S, Rispo A, Scribano ML, et al. Azathioprine for prevention of clinical recurrence in Crohn’s disease patients with severe endoscopic recurrence: an IG-IBD randomized double-blind trial. Eur Rev Med Pharmacol Sci. 2020;24:11356–64.

    CAS  PubMed  Google Scholar 

  105. Papamichael K, Archavlis E, Lariou C, Mantzaris GJ. Adalimumab for the prevention and/or treatment of post-operative recurrence of Crohn’s disease: a prospective, two-year, single center, pilot study. J Crohns Colitis. 2012;6:924–31.

    Article  PubMed  Google Scholar 

  106. Savarino E, Bodini G, Dulbecco P, Assandri L, Bruzzone L, Mazza F, et al. Adalimumab is more effective than azathioprine and mesalamine at preventing postoperative recurrence of Crohn’s disease: a randomized controlled trial. Am J Gastroenterol. 2013;108:1731–42.

    Article  CAS  PubMed  Google Scholar 

  107. Beelen EMJ, Nieboer D, Arkenbosch JHC, Regueiro MD, Satsangi J, Ardizzone S, et al. Risk prediction and comparative efficacy of anti-TNF vs thiopurines, for preventing postoperative recurrence in Crohn’s disease: a pooled analysis of 6 trials. Clin Gastroenterol Hepatol. 2022;20:2741-2752.e6.

    Article  CAS  PubMed  Google Scholar 

  108. Kotze PG, Yamamoto T, Danese S, Suzuki Y, Teixeira FV, de Albuquerque IC, et al. Direct retrospective comparison of adalimumab and infliximab in preventing early postoperative endoscopic recurrence after ileocaecal resection for Crohn’s disease: results from the MULTIPER database. J Crohns Colitis. 2015;9:541–7.

    Article  PubMed  Google Scholar 

  109. • Gangwani MK, Nawras M, Aziz M, Rani A, Priyanka F, Dahiya DS, et al. Comparing adalimumab and infliximab in the prevention of postoperative recurrence of Crohn’s disease: a systematic review and meta-analysis. Ann Gastroenterol. 2023;36:293–9. Recent meta analysis demonstrating no comparative difference between infliximab and adalimumab in prevention of POR.

    PubMed  PubMed Central  Google Scholar 

  110. Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med. 2010;362:1383–95.

    Article  CAS  PubMed  Google Scholar 

  111. Axelrad JE, Li T, Bachour SP, Nakamura TI, Shah R, Sachs MC, et al. Early initiation of antitumor necrosis factor therapy reduces postoperative recurrence of Crohn’s disease following ileocecal resection. Inflamm Bowel Dis. 2023;29:888–97.

    Article  PubMed  Google Scholar 

  112. Yanai H, Kagramanova A, Knyazev O, Sabino J, Haenen S, Mantzaris GJ, et al. Endoscopic postoperative recurrence in Crohn’s disease after curative ileocecal resection with early prophylaxis by anti-TNF, vedolizumab or ustekinumab: a real-world multicentre european study. J Crohns Colitis. 2022;16:1882–92.

    Article  PubMed  Google Scholar 

  113. Brierley R. 18th congress of the european Crohn’s and Colitis organisation. Lancet Gastroenterol Hepatol. 2023;8:404.

    Article  PubMed  Google Scholar 

  114. •• D’Haens G, Taxonera C, Lopez-Sanroman A, Nos Mateu P, Danese S, Armuzzi A, et al. Prevention of postoperative recurrence of Crohn’s disease with vedolizumab: First results of the prospective placebo-controlled randomised trial REPREVIO. J Crohn’s Colitis. 2023;17:i19. First RCT demonstrating that vedolizumab is effective and safe in the prevention of POR of Crohn's disease.

    Article  Google Scholar 

  115. Buisson A, Nancey S, Manlay L, Rubin DT, Hebuterne X, Pariente B, et al. Ustekinumab is more effective than azathioprine to prevent endoscopic postoperative recurrence in Crohn’s disease. United European Gastroenterol J. 2021;9:552–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Allez M. OP067: Comparitive effectiveness of ustekinumab and adalimumab in the prevention of post-operative recurrence in Crohn’s disease. Copenhagen: Denmark; 2023.

    Google Scholar 

  117. Joustra V, van Sabben J, van der does de Willebois E, Duijvestein M, de Boer N, Jansen J, et al. Benefit of Risk-stratified Prophylactic Treatment on Clinical Outcome in Postoperative Crohn’s Disease. J Crohn’s Colitis. 2023;17:318–28.

    Article  Google Scholar 

  118. •• Arkenbosch JHC, Beelen EMJ, Dijkstra G, Romberg-Camps M, Duijvestein M, Hoentjen F, et al. Prophylactic Medication for the prevention of endoscopic recurrence in Crohn’s disease: a prospective study based on clinical risk stratification. J Crohns Colitis. 2023;17:221–30. Large, multicenter prospective study showing that prophylactic biologics help prevent POR in both high-risk and low-risk patients.

    Article  PubMed  Google Scholar 

  119. Bachour SP, Shah RS, Rieder F, Cohen B, Qazi T, Lashner B, et al. S712 late postoperative crohn’s disease recurrence is common and differs by baseline inflammation. Off J Am Coll Gastroenterol ACG. 2021;116:S324.

    Article  Google Scholar 

  120. Pouillon L, Remen T, Amicone C, Louis E, Maes S, Reenaers C, et al. Risk of late postoperative recurrence of Crohn’s disease in patients in endoscopic remission after ileocecal resection, over 10 years at multiple centers. Clin Gastroenterol Hepatol. 2021;19:1218-1225.e4.

    Article  PubMed  Google Scholar 

  121. Yamamoto T, Umegae S, Matsumoto K. Impact of infliximab therapy after early endoscopic recurrence following ileocolonic resection of Crohn’s disease: a prospective pilot study. Inflamm Bowel Dis. 2009;15:1460–6.

    Article  PubMed  Google Scholar 

  122. Macaluso FS, Grova M, Mocciaro F, Di Mitri R, Privitera AC, et al. Sicilian Network for Inflammatory Bowel Disease (SN-IBD). Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn’s disease. J Gastroenterol Hepatol. 2023;38(9):1503–9. https://doi.org/10.1111/jgh.16208.

    Article  CAS  PubMed  Google Scholar 

  123. Bachour SP, Shah RS, Joseph A, Syed H, Ali AH, et al. Change in biologic class promotes endoscopic remission following endoscopic postoperative Crohn’s disease recurrence. J Clin Gastroenterol. 2023. https://doi.org/10.1097/MCG.0000000000001943.

Download references

Author information

Authors and Affiliations

  1. Brigham and Women’s Hospital, Department of Medicine, Boston, MA, 02115, USA

    Salam P. Bachour

  2. University of Colorado Anschutz Medical Campus, Division of Gastroenterology and Hepatology, 13001 E 17th Pl, Aurora, CO, 80045, USA

    Benjamin H. Click

Authors
  1. Salam P. Bachour
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin H. Click
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin H. Click.

Ethics declarations

Conflict of interests

SB has no disclosures to report. BC reports consulting/advisory boards for AbbVie, Bristol Meyers Squibb, Janssen, Takeda, Pfizer, Prometheus, TARGET-RWE.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bachour, S.P., Click, B.H. Clinical Update on the Prevention and Management of Postoperative Crohn’s Disease Recurrence. Curr Gastroenterol Rep 26, 41–52 (2024). https://doi.org/10.1007/s11894-023-00911-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-023-00911-7

Keywords

Search

Navigation