Medical therapy to reduce postoperative Crohn's disease recurrence

Clinical recurrence of Crohn's disease after surgical resection is a signif icant problem, with reported rates as high as 55% at 5 yr and 76% at 15 yr. Specific factors that predispose to postoperative recurrence of Crohn's di sease have not been well defined. In addition, the underlying pathophysiolo gy of recurrent disease and the reason for its localization to the neotermi nal ileum are not well understood. Various operative techniques have been e valuated but none, aside from formation of an ostomy, has been shown to red uce the risk of recurrence. In contrast, there is increasing evidence that postoperative medical therapy has the potential to decrease the risk of pos toperative recurrence. Historically, sulfasalazine may have a modest effect on reducing postoperat ive recurrence of ileal or ileocolonic disease. However, 5-ASA preparations that can selectively deliver mesalamine to the small bowel or anastomotic margin should be more effective. Indeed, in several studies and as confirme d by a meta-analysis, mesalamine has been demonstrated to reduce significan tly postoperative recurrence of Crohn's disease. Metronidazole and 6-mercap topurine or azathioprine also seem to be of benefit in postoperative prophy laxis of disease recurrence, but additional controlled studies are required to define better the efficacy and dose-response of these agents. Corticost eroids are ineffective at reducing postoperative recurrence. (C) 2000 by Am . Cell. of Gastroenterology.