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16-01-2024 | Crohn's Disease

Clinical Update on the Prevention and Management of Postoperative Crohn’s Disease Recurrence

Authors: Salam P. Bachour, Benjamin H. Click

Published in: Current Gastroenterology Reports | Issue 2/2024

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Abstract

Purpose of Review

Despite advances in therapeutics, a significant portion of patients with Crohn’s disease still require surgical management. In this article, we present updates to the natural history, prognostication and postoperative monitoring, and novel therapeutics in the prevention and treatment of postoperative Crohn’s disease recurrence.

Recent Findings

Clinical risk factors have been associated with higher rates of postoperative recurrence (POR), and in recent studies demonstrate an increased cumulative risk with presence of additional risk factors. Additional novel clinical, histologic, and “-omic” risk factors for recurrence have recently been elucidated, including the role of the mesentery on recurrence and perioperative intraabdominal septic complications. High-risk patients benefit most from medical prophylaxis, including anti-TNF with or without immunomodulator therapy to prevent recurrence. New biologics such as vedolizumab and ustekinumab have emerging evidence in the use of prophylaxis, especially with recent REPREVIO trial data. Non-invasive disease monitoring, such as cross-sectional enterography, intestinal ultrasound, and fecal calprotectin, have been validated against ileocolonoscopy.

Summary

Recent advances in the prediction, prevention, and monitoring algorithms of postoperative Crohn’s disease may be leading to a reduction in postoperative recurrence. Ongoing trials will help determine optimal monitoring and management strategies for this at-risk population.
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Metadata
Title
Clinical Update on the Prevention and Management of Postoperative Crohn’s Disease Recurrence
Authors
Salam P. Bachour
Benjamin H. Click
Publication date
16-01-2024
Publisher
Springer US
Published in
Current Gastroenterology Reports / Issue 2/2024
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-023-00911-7
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