Management of Crohn’s Disease After Surgical Resection
Publication Date: January 2, 2017
Last Updated: December 16, 2022
Management
Recommendations for the Management of Crohn’s Disease After Surgical Resection
In patients with surgically induced remission of CD, AGA suggests early pharmacological prophylaxis over endoscopy-guided pharmacological treatment. ( Very Low , Conditional (weak) )
Comments: Patients, particularly those at lower risk of recurrence, who place a higher value on avoiding the small risks of adverse events from pharmacological prophylaxis and a lower value on the potential risk of early disease recurrence may reasonably select endoscopy-guided pharmacological treatment over prophylaxis.
612
In patients with surgically induced remission of CD, AGA suggests using anti-TNF therapy and/or thiopurines over other agents. ( Moderate , Conditional (weak) )
Comments: Patients at lower risk of disease recurrence or who place a higher value on avoiding the small risk of adverse events of thiopurines or anti-TNF treatment and a lower value on a modestly increased risk of disease recurrence may reasonably choose nitroimidazole antibiotics (for 3–12 months).
612
In patients with surgically induced remission of CD, AGA suggests against using mesalamine (or other 5-aminosalicylates), budesonide, or probiotics. ( Very Low , Conditional (weak) )
612
In patients with surgically induced remission of CD receiving pharmacological prophylaxis, AGA suggests postoperative endoscopic monitoring at 6–12 months after surgical resection over no monitoring. ( Moderate , Conditional (weak) )
612
In patients with surgically induced remission of CD not receiving pharmacological prophylaxis, AGA recommends postoperative endoscopic monitoring at 6–12 months after surgical resection over no monitoring. ( Moderate , Strong )
612
In patients with surgically induced remission of CD with asymptomatic endoscopic recurrence, AGA suggests initiating or optimizing anti-TNF and/or thiopurine therapy over continued monitoring alone. ( Moderate , Conditional (weak) )
Comments: Patients who place a higher value on avoiding the small risk of adverse events of thiopurines or anti-TNF treatment and a lower value on the increased risk of clinical recurrence following asymptomatic endoscopic recurrence may reasonably choose continued endoscopic monitoring.
612
Overview
Title
Management of Crohn’s Disease After Surgical Resection
Authoring Organization
American Gastroenterological Association