Management of Crohn's Disease
Publication Date: January 2, 2017
Key Points
Key Points
Nearly one-half of patients with Crohn’s disease (CD) will require bowel resection within the first 10 years of disease.
However, surgery is not curative, and one-fourth of these patients will require at least another bowel resection within five years of index surgery.
Surgical recurrence is usually preceded by endoscopic and clinical recurrence. Endoscopic recurrence can occur in the neoterminal ileum in as many as 90% of patients within 12 months of surgical resection.
Certain clinical features, such as the presence of penetrating disease, cigarette smoking, and multiple prior resections, are risk factors for disease recurrence.
The presence and severity of endoscopic recurrence, as measured by the Rutgeerts’ score, is a strong predictor of clinical and surgical recurrence.
The prevention of postoperative disease recurrence is a high priority given the morbidity associated with clinical and surgical recurrence and the long-term risk of short gut syndrome that may arise from multiple bowel resections.
However, surgery is not curative, and one-fourth of these patients will require at least another bowel resection within five years of index surgery.
Surgical recurrence is usually preceded by endoscopic and clinical recurrence. Endoscopic recurrence can occur in the neoterminal ileum in as many as 90% of patients within 12 months of surgical resection.
Certain clinical features, such as the presence of penetrating disease, cigarette smoking, and multiple prior resections, are risk factors for disease recurrence.
The presence and severity of endoscopic recurrence, as measured by the Rutgeerts’ score, is a strong predictor of clinical and surgical recurrence.
The prevention of postoperative disease recurrence is a high priority given the morbidity associated with clinical and surgical recurrence and the long-term risk of short gut syndrome that may arise from multiple bowel resections.
Management
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Management Algorith...