Advances in Postoperative Crohn’s Disease Management Aim to Reduce Recurrence Rates

Despite significant progress in medical therapies for Crohn’s disease, a substantial number of patients still require surgical intervention. A recent review published in Current Gastroenterology Reports outlines key updates in predicting, preventing, and monitoring postoperative recurrence (POR), offering practical guidance for clinicians managing this high-risk population.

The study highlights a growing understanding of risk stratification in postoperative Crohn’s disease. “Clinical risk factors have been associated with higher rates of postoperative recurrence,” the authors note, emphasizing that recurrence risk increases with the accumulation of multiple risk factors. Recent studies have expanded this list to include histologic and molecular (“-omic”) markers, as well as the presence of perioperative intra-abdominal septic complications and mesenteric involvement.

These insights are helping guide individualized treatment plans. “High-risk patients benefit most from medical prophylaxis, including anti-TNF with or without immunomodulator therapy to prevent recurrence,” the study states. For patients intolerant to anti-TNF agents or in whom additional biologic options are being considered, newer agents such as vedolizumab and ustekinumab are gaining traction. The authors highlight recent evidence from the REPREVIO trial, which supports the use of these biologics for postoperative prophylaxis.

Monitoring strategies are also evolving beyond traditional ileocolonoscopy. “Non-invasive disease monitoring, such as cross-sectional enterography, intestinal ultrasound, and fecal calprotectin, have been validated against ileocolonoscopy,” the authors report. These tools may offer more accessible and patient-friendly approaches to early detection of recurrence, allowing for timely intervention.

The review concludes that advances in risk prediction, prophylactic therapy, and noninvasive monitoring “may be leading to a reduction in postoperative recurrence.” As ongoing clinical trials continue to refine best practices, gastroenterologists are better equipped to tailor postoperative management and improve outcomes in Crohn’s disease.

Reference
Bachour SP, Click BH. Clinical update on the prevention and management of postoperative crohn's disease recurrence. Curr Gastroenterol Rep. 2024;26(2):41-52. doi:10.1007/s11894-023-00911-7