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Postoperative Approach for Crohn's Disease: The Right Therapy to the Right Patient

[ Vol. 19 , Issue. 7 ]

Author(s):

Paulo Gustavo Kotze*, Takayuki Yamamoto and Aderson O.M.C. Damiao   Pages 729 - 739 ( 11 )

Abstract:


Background: Recurrence is a common event after surgical resections secondary to Crohn's disease (CD). Endoscopic signs of inflammation, defined as postoperative endoscopic recurrence (PER) occur in up to 90% of the patients after one year. PER precedes clinical recurrence and further need for reoperations due to consequent bowel damage. Therefore, controlling inflammation after surgery in a preventive way is essential for disease control.

Objective: to review data regarding PER in CD, and demonstrate algorithms for its management after surgery.

Results: There is no fixed strategy to prevent recurrence after surgery in CD. There are several risk factors that must be taken into consideration to guide physicians to choose the best therapeutic agents and strategies in this scenario. In this review, the authors describe in details the stratification based on risk factors, the therapeutic agents mostly used to prevent recurrence and discuss the several options for the postoperative management in CD.

Conclusions: No fixed strategy is recommended after surgical resections in CD. Thus, the need for a personalized approach for each patient is emphasized, in accordance with several conditions and variables.

Keywords:

Crohn´s disease, recurrence, postoperative care, inflammation, postoperative endoscopic recurrence, therapy.

Affiliation:

Colorectal Surgery Unit, Catholic University of Parana (PUCPR), Curitiba, IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Gastroenterology Department, University of Sao Paulo Medical School (FMUSP), Sao Paulo

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