Postoperative recurrence in Crohn's disease

Intestinal resection in the natural history of Crohn's disease is a forced step. Unfortunately surgery is not curative as disease inexorably recurs. The frequency of recurrence varies according to the definitions adopted, being high when endoscopical criteria are used (70-90% at one year). Among risk factors, the most convincing is a smoking habit. The pathogenesis of recurrence is still unknown. Particular attention was paid to colo-ileal reflux which occurs after the resection of the ileocecal valve. The diagnosis should always be based on morphological criteria (endoscopy or radiology). In fact symptoms occur late and are often uncharacteristic. A particular problem in the management of patients with Crohn's disease is the prevention of post-operative recurrence. Recent randomized, controlled trials of which the first has been published by the authors of this article, demonstrated that the administration of 5-ASA early after resection may prevent, delay or attenuate such recurrences. Cessation of smoking also plays a central role in prevention. The final message is that in active Crohn's disease surgery should not be excessively delayed. Early resection followed by prophylactic treatment seems to improve the quality of life in patients with more severe Crohn's disease.