GASTROENTEROLOGY ARTICLE OF THE WEEK
August 28, 2008
Terdiman JP. Prevention of postoperative recurrence in Crohn’s Disease. Clin Gastroenterol Hepatol 2008;6:616-620.
1. A patient is seeing you in clinic 6 weeks after short-segment ileal resection for fibrostenotic Crohn’s. She is asymptomatic, consumes only organic foods and dislikes taking any medications. She asks you what are her chances of recurrence of disease (with or without symptoms) if she takes no medications. You should tell her:
a. <30% endoscopic recurrence in 1 year
b. 5% per year
c. 60% or greater in 1 year if routine endoscopy done, ½ or more of these
recurrences are severe.
d. 10%-30% clinical recurrence at 1 year, 75%-80% at 10 years
2. The patient then asks you whether instead of taking poisons (medications) all the time, she can have routine endoscopy at 6 months and be treated only when active disease found. You tell her
a. No, treatment started before mucosal disease is more effective
b. No, she is likely to flare clinically between endoscopies and become ill
c. Yes, that is as effective as pre-emptive treatment
e. No, she should start mesalamine treatment right away, which has consistently
been found to be more effective than no treatment in preventing recurrence
f. No, data clearly shows that prompt initiation of therapy with TNF inhibitors is
very effective in preventing disease recurrence.
True or False
3. After surgery for Crohn’s disease, recurrence typically occurs at a site away from the surgical anastomosis
4. Resections that create an anastomosis as far away from active disease as possible are less likely to result in recurrence than less radical surgery
5. Colonoscopy every 6-12 months after surgical resection to guide initiation of therapy is a proven way of diminishing need for re-operation
6. Tobacco use after surgery has been found to consistently increase the risk of recurrence
7. Patients who undergo operation for isolated small bowel disease are more likely to recur than those who have ileocolic disease as the reason for the operation
8. Patient with high-risk criteria for relapse should be started on 6-MP or azathioprine after surgery and before the 6 month post-operative colonoscopy
9. The absence of mucosal lesions, or only very mild lesions found on colonoscopy 1 year after resection predicts a very good prognosis with low rates of relapse