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Postoperative Crohn’s Disease

  • Kurvi Patwala
  • Peter De Cruz
Chapter

Abstract

This chapter will cover prognostic and predictive biomarkers that have been identified in association with postoperative recurrence of Crohn’s disease. It will discuss the optimal management of Crohn’s disease following resectional surgery with reference to the natural history of Crohn’s disease after surgery, risk factors for earlier postoperative recurrence, diagnosis and monitoring of recurrence and therapeutic strategies to address prevention of recurrence. It will provide a clinical algorithm encompassing biomarkers to help guide clinical management as well as identify future directions for ongoing research.

References

  1. 1.
    Bouguen G, Peyrin-Biroulet L. Surgery for adult Crohn’s disease: what is the actual risk? Gut. 2011;60:1178–81.CrossRefGoogle Scholar
  2. 2.
    Farmer RG, Hawk WA, Turnbull RB. Efficacy and complications of surgery for Crohn’s disease. Gastroenterol Hepatol. 2010;6(9):587–96.Google Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    Rutgeerts P, Geboes K, Vantrappen G, et al. Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut. 1984;25:665–72.CrossRefGoogle Scholar
  5. 5.
    Rutgeerts P, Geboes K, Vantrappen G, et al. Predictability of the postoperative course of Crohn’s disease. Gastroenterology. 1990;99:956–63.CrossRefGoogle Scholar
  6. 6.
    Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231:38–45.CrossRefGoogle Scholar
  7. 7.
    D’Haens GR, Geboes K, Peeters M, et al. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology. 1998;114(2):262.CrossRefGoogle Scholar
  8. 8.
    Rutgeerts P, Goboes K, Peeters M, et al. Effect of faecal stream diversion on recurrence of Crohn’s disease in the neoterminal ileum. Lancet. 1991;338(8770):771.CrossRefGoogle Scholar
  9. 9.
    De Cruz P, Kamm MA, Prideaux L, et al. Postoperative recurrent luminal Crohn’s disease: a systematic review. Inflamm Bowel Dis. 2012;18:758–77.CrossRefGoogle Scholar
  10. 10.
    De Cruz P, Kamm MA, Hamilton AL, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet. 2015;385(9976):1406–17.CrossRefGoogle Scholar
  11. 11.
    Simillis C, Yamamoto T, Reese GE, 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.CrossRefGoogle Scholar
  12. 12.
    Rutgeerts P, Van Assche G. What is the role of endoscopy in the postoperative management of Crohn’s disease? Inflamm Bowel Dis. 2008;14(suppl 2):S179–80.CrossRefGoogle Scholar
  13. 13.
    Tibble JA, Bjarnason I. Non-invasive investigation of inflammatory bowel disease. World J Gastroenterol. 2001;7(4):460–5.CrossRefGoogle Scholar
  14. 14.
    Gisbert JP, McNicholl AG. Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease. Dig Liver Dis. 2009;41:56–66.CrossRefGoogle Scholar
  15. 15.
    Gisbert JP, McNicholl AG, Gomollon F. Questions and answers on the role of fecal lactoferrin as a biological marker in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:1746–54.CrossRefGoogle Scholar
  16. 16.
    Wright E, De Cruz P, Gearry R, et al. Fecal biomarkers in the diagnosis and monitoring of Crohn’s disease. Inflamm Bowel Dis. 2014;20:1668–77.CrossRefGoogle Scholar
  17. 17.
    Steinbakk M, Naess-Andresen CF, Lingaas E, et al. Antimicrobial actions of calcium binding leucocyte L1 protein, calprotectin. Lancet. 1990;336:763–5.CrossRefGoogle Scholar
  18. 18.
    Roseth AG, Fagerhol MK, Aadland E, et al. Assessment of the neutrophil dominating protein calprotectin in feces. A methodologic study. Scand J Gastroenterol. 1992;27:793–8.CrossRefGoogle Scholar
  19. 19.
    Wright EK, Kamm MA, De Cruz P, et al. Measurement of fecal calprotectin improves monitoring and detection of recurrence of Crohn’s disease after surgery. Gastroenterology. 2015;148:938–47.CrossRefGoogle Scholar
  20. 20.
    Prideaux L, De Cruz P, Ng SC, et al. Serological antibodies in inflammatory bowel disease: a systematic review. Inflamm Bowel Dis. 2012;18(7):1340–55.CrossRefGoogle Scholar
  21. 21.
    Hamilton AL, Kamm MA, De Cruz P, et al. Serologic antibodies in relation to outcome in postoperative Crohn’s disease. J Gastroenterol Hepatol. 2017;32(6):1195–203.CrossRefGoogle Scholar
  22. 22.
    Ruemmele FM, Targan SR, Levy G, et al. Diagnostic accuracy of serological assays in pediatric inflammatory bowel disease. Gastroenterology. 1998;115:822–9.CrossRefGoogle Scholar
  23. 23.
    Rutgeerts P, Hiele M, Geboes K, et al. Controlled trial of metronidazole treatment for prevention of Crohn’s recurrence after ileal resection. Gastroenterology. 1995;108:1617–21.CrossRefGoogle Scholar
  24. 24.
    D’Haens GR, Vermeire S, Van Assche G, et al. Therapy of metronidazole with azathioprine to prevent postoperative recurrence of Crohn’s disease: a controlled randomized trial. Gastroenterology. 2008;135:1123–9.CrossRefGoogle Scholar
  25. 25.
    Rutgeerts P, Van Assche G, Vermeire S, et al. Ornidazole for prophylaxis of postoperative Crohn’s disease recurrence: a randomized, double-blind, placebo-controlled trial. Gastroenterology. 2005;128:856–61.CrossRefGoogle Scholar
  26. 26.
    Doherty GA, Bennett GC, Cheifetz AS, et al. Meta-analysis: targeting the intestinal microbiota in prophylaxis for post-operative Crohn’s disease. Aliment Pharmacol Ther. 2010;31:802–9.PubMedGoogle Scholar
  27. 27.
    Neurath M. Thiopurines in IBD. Gastroenterol Heaptol. 2010;6(7):435–6.Google Scholar
  28. 28.
    Mowat C, Arnott I, Cahill A, et al. Mercaptopurine versus placebo to prevent recurrence of Crohn’s disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial. Lancet Gastroenterol Hepatol. 2016;1(4):273–82.CrossRefGoogle Scholar
  29. 29.
    Regueiro M, Schraut W, Baidoo L, et al. Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology. 2009;136:441–50.CrossRefGoogle Scholar
  30. 30.
    De Cruz P, Kamm MA, Hamilton AL, et al. Adalimumab prevents post-operative Crohn’s disease recurrence, and is superior to thiopurines: early results from the POCER study. Gastroenterology. 2012;142:S–212.Google Scholar
  31. 31.
    Regeuiro M, Feagan B, Zou B, et al. Infliximab reduces endoscopic, but not clinical, recurrence of Crohn’s disease after ileocolonic resection. Gastroenterology. 2016;150(7):1568–78.CrossRefGoogle Scholar
  32. 32.
    De Cruz P, Kamm MA, Hamilton AL, et al. Crohn’s disease management after intestinal resection: a randomised trial. Lancet. 2015;38599976:1406–17.CrossRefGoogle Scholar
  33. 33.
    De Cruz P, Kamm MA, Hamilton AL, 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(7):867–79.CrossRefGoogle Scholar
  34. 34.
    ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb 29 – Identifier NCT02834754, A randomised, double-blind, placebo controlled study of vedolizumab for the prevention of post-operative Crohn’s disease recurrence (Vedo Post-op); 2016 [cited 2017 Oct 28]. Available from: https://clinicaltrials.gov/ct2/show/NCT02834754.
  35. 35.
    Saffouri E, Kemp L, Muir A, et al. PTU-140 Vedolizumab is an effective therapy in postoperative ileal crohns following loss of response to anti-tnf. Gut. 2017;66:A119–20.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kurvi Patwala
    • 1
  • Peter De Cruz
    • 1
    • 2
  1. 1.Department of GastroenterologyAustin HealthMelbourneAustralia
  2. 2.Department of MedicineThe University of MelbourneMelbourneAustralia

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