Abstract
The course of Crohn’s disease (CD) is especially aggressive in paediatric CD, with surgical resection of intestinal macroscopic lesions often being necessary, Unfortunately, surgery is not curative, and most patients experience postoperative disease recurrence within years of undergoing the initial surgery. Paediatric CD patients have a higher lifelong risk of repeated surgical interventions than adults, and preventing disease recurrence is of utmost importance to ensure growth and quality of life. Prevention generally involves prophylactic drugs (e.g. anti-TNFα, thiopurines, metronidazole), as well as early and regular monitoring (with fecal calprotectin levels and ileocolonoscopy), with step-up therapy as needed.
Similar content being viewed by others
References
Vuitton L, Peyrin-Biroulet L. Pharmacological prevention of postoperative recurrence in Crohn’s disease. Drugs. 2020;80(4):385–99.
Yerushalmy-Feler A, Assa A. Pharmacological prevention and management of postoperative relapse in pediatric Crohn’s disease. Paediatr Drugs. 2019;21(6):451–60.
Splawski JB, Pffefferkorn MD, Schaefer ME, et al. NASPGHAN clinical report on postoperative recurrence in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2017;65(4):475–86.
Amil-Dias J, Kolacek S, Turner D. Surgical management of Crohn disease in children: guidelines from the paediatric IBD Porto Group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2017;64(5):818–35.
Hammoudi N, Cazals-Hatem D, Auzolle C. Association between microscopic lesions at ileal resection margin and recurrence after surgery in patients with Crohn’s disease. Clin Gastroenterol Hepatol. 2019;18(1):141–9.
Auzolle C, Nancey S, Tran-Minh ML. 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(9):924–32.
Ruemmele FM, Veres G, Kolho KL. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis. 2014;8:1179–207.
Orlando A, Mocciaro F, Renna S, et al. Early post-operative endoscopic recurrence in Crohn’s disease patients: data from an Italian Group for the study of inflammatory bowel disease (IG-IBD) study on a large prospective multicenter cohort. J Crohns Colitis. 2014;8(10):1217–21.
Hukkinen M, Pakarinen MP, Merras-Salmio L. Fecal calprotectin in the prediction of postoperative recurrence of Crohn’s disease in children and adolescents. J Pediatr Surg. 2016;51(9):1467–72.
Rivière P, Vermeire S, Irles-Depe M. 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(8):1643–5.
Gjuladin-Hellon T, Gordon M, Iheozor-Ejiofor Z, et al. Oral 5-aminosalicylic acid for maintenance of surgically-induced remission in Crohn’s disease. Cochrane Database Syst Rev. 2019;6(6):CD008414.
Ford AC, Khan KJ, Talley NJ, et al. 5-aminosalicylates prevent relapse of Crohn’s disease after surgically induced remission: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(3):413–20.
Doherty G, Bennett G, Patil S, et al. Interventions for prevention of post-operative recurrence of Crohn’s disease. Cochrane Database Syst Rev. 2009;7(4):CD006873.
Regueiro M, Schraut W, Baidoo L, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology. 2009;136(2):441–50.
Rutgeerts P, Hiele M, Geboes K. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108(6):1617–21.
Yamamoto T, Nakahigashi M, Umegae S, et al. Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: a prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther. 2007;25(1):67–72.
Author information
Authors and Affiliations
Contributions
ESK searched the literature, prepared the bibliography and wrote the first draft. YAH contributed to the preparation, content, writing and revision of the article.
Corresponding author
Ethics declarations
Funding
The preparation of this review was not supported by any external funding. ESK and YAH are employed by Adis International Ltd./Springer Nature.
Conflict of interest
ESK and YAH declare no relevant conflicts of interest.
Rights and permissions
About this article
Cite this article
Kim, E.S., Heo, YA. Prevent postoperative recurrence of paediatric Crohn’s disease by risk-based treatment and early monitoring. Drugs Ther Perspect 36, 377–381 (2020). https://doi.org/10.1007/s40267-020-00758-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40267-020-00758-2