Review article: the natural history of postoperative Crohn's disease recurrence.
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TLDR
Surgical resection of the diseased bowel in Crohn's disease is unfortunately not curative, and postoperative recurrence remains a problem in these patients.Abstract:
Summary
Background
Surgical resection of the diseased bowel in Crohn's disease is unfortunately not curative, and postoperative recurrence remains a problem in these patients.
Aim
To review the rates of and risk factors for clinical and endoscopic recurrence in population-based studies, referral centres and randomised controlled trials.
Methods
We searched MEDLINE (source PUBMED, 1966 to September, 2011).
Results
In randomised controlled trials, clinical recurrence in the first year after surgery occurred in 10–38% of patients, whereas endoscopic recurrence in the first year was reported in 35–85% of patients. In population-based studies, approximately half of patients experienced clinical recurrence at 10 years. In referral centres, 48–93% of the patients had endoscopic lesions (Rutgeerts’ score ≥1) in the neoterminal ileum within 1 year after surgery, whereas 20–37% had symptoms suggestive of clinical recurrence. Three years after surgery, the endoscopic postoperative recurrence rate increased to 85–100%, and symptomatic recurrence occurred in 34–86% of patients. Smoking is the strongest risk factor for postoperative recurrence, increasing by twofold, the risk of clinical recurrence. Prior intestinal resection, penetrating behaviour, perianal disease and extensive bowel disease (>50 cm) are established risk factors for postoperative recurrence. Risk factors for postoperative recurrence remain poorly defined in population-based cohorts.
Conclusion
Endoscopic and clinical postoperative recurrence remains common in patients with Crohn's disease, and the identification of risk factors may allow targeted strategies to reduce this recurrence rate.read more
Citations
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Crohn's disease
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British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults
Christopher A. Lamb,Christopher A. Lamb,Nicholas A. Kennedy,Tim Raine,P Hendy,P Hendy,Philip J Smith,Jimmy K. Limdi,Jimmy K. Limdi,Bu'Hussain Hayee,Bu'Hussain Hayee,Miranda Lomer,Miranda Lomer,Gareth Parkes,Gareth Parkes,Christian P. Selinger,Christian P. Selinger,Kevin Barrett,R Justin Davies,Cathy Bennett,Stuart Gittens,Malcolm G. Dunlop,Malcolm G. Dunlop,Omar Faiz,Aileen Fraser,Vikki Garrick,Paul D Johnston,Miles Parkes,Jeremy D. Sanderson,Jeremy D. Sanderson,Helen Terry,Daniel R. Gaya,Daniel R. Gaya,Tariq Iqbal,Tariq Iqbal,Stuart A. Taylor,Stuart A. Taylor,Melissa A. Smith,Melissa A. Smith,Matthew J Brookes,Richard Hansen,A Barney Hawthorne +41 more
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TL;DR: Given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications.
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Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn's disease: a randomised controlled, open-label, multicentre trial
Cyriel Y. Ponsioen,E. Joline de Groof,Emma J. Eshuis,Tjibbe J. Gardenbroek,Patrick M.M. Bossuyt,Ailsa Hart,Janindra Warusavitarne,Christianne J. Buskens,Ad A. van Bodegraven,Menno A. Brink,Esther C. J. Consten,Bart A. van Wagensveld,Marno C.M. Rijk,Rogier M P H Crolla,Casper G. Noomen,Alexander P.J. Houdijk,Rosalie C Mallant,Maarten J Boom,Willem A. Marsman,H. B. A. C. Stockmann,Bregje Mol,A Jeroen de Groof,Pieter C. F. Stokkers,Geert R. D'Haens,Willem A. Bemelman,Karlien F. Bruin,John Maring,Theo J.M. van Ditzhuijsen,Hubert A Prins,Jan van den Brande,Paul Kingma,Anna A. W. van Geloven,Nanne K. H. de Boer,Donald L. van der Peet,Jeroen M. Jansen,Michael F. Gerhards,Janneke van der Woude,Ruud Schouten,Bas Oldenburg,Richard van Hillegersberg,Rachel L. West,Guido Mannaerts,Marcel Spanier,Ernst Jan Spillenaar Bilgen,Rob J. Lieverse,Edwin S. van der Zaag,Annekatrien Depla,Arnold van de Laar,Clemens Bolwerk,Hans Brouwer,Nofel Mahmmod,Eric J. Hazebroek,Juda Vecht,Robert E G J M Pierik,Gerard Dijkstra,Sijbrand Hofker,Tessa Uiterwaal,Quirijn A. J. Eijsbouts,Liekele Oostenbrug,Meindert N. Sosef,Djuna Cahen,Sjoerd van der Werff,Andreas Marinelli,Job H.C. Peters,Huib A. Cense,Nynke Talstra,Pritesh Morar +66 more
TL;DR: In this randomised controlled, open-label trial, adults with non-stricturing, ileocaecal Crohn's disease, in whom conventional therapy has failed were randomly allocated to have resection or receive infliximab to assess how they affect health-related quality of life.
References
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Journal ArticleDOI
Predictability of the postoperative course of Crohn's disease
TL;DR: The early postoperative lesions in the neoterminal ileum seem to be a suitable model to study the pathogenesis of Crohn's disease and also to evaluate new therapeutic modalities, either to prevent development of these early lesions or to treat progressive recurrence.
Journal ArticleDOI
The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations
Gert Van Assche,Axel Dignass,Walter Reinisch,C. Janneke van der Woude,Andreas Sturm,Martine De Vos,Mario Guslandi,Bas Oldenburg,Iris Dotan,Philippe Marteau,Alessandro Ardizzone,Daniel C. Baumgart,Geert R. D'Haens,Paolo Gionchetti,Francisco Portela,Boris Vucelić,Johan D. Söderholm,Johanna C. Escher,Sibylle Koletzko,Kaija-Leena Kolho,Milan Lukas,Christian Mottet,Herbert Tilg,Severine Vermeire,F. Carbonnel,Andrew T. Cole,Gottfried Novacek,Max Reinshagen,Epameinondas V. Tsianos,Klaus Herrlinger,Yoram Bouhnik,Ralf Kiesslich,Eduard F. Stange,Simon Travis,James O. Lindsay +34 more
TL;DR: The aim of this Consensus was therefore critically to evaluate the optimal strategies for the management of post-operative recurrence in CD.
Journal ArticleDOI
The Natural History of Adult Crohn's Disease in Population-Based Cohorts
TL;DR: This comprehensive review summarizes the current knowledge of the natural history of Crohn's disease in adults as reported in population-based studies that include long-term follow-up results.
Journal ArticleDOI
Controlled trial of metronidazole treatment for prevention of crohn's recurrence after ileal resection☆
Paul Rutgeerts,Martin Hiele,Karel Geboes,Marc Peeters,Freddy Penninckx,Raymond Aerts,Raymond Kerremans +6 more
TL;DR: Metronidazole therapy for 3 months decreases the severity of early recurrence of Crohn's disease in the neoterminal ileum after resection and seems to delay symptomatic recurrence.
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