Preventing Recurrence After Crohn's Disease Surgery

Surgery can be a very effective way of managing your Crohn's disease. However, Crohn's disease can come back in parts of the intestine that were previously not affected. As a result, it is not unheard of for people with Crohn's disease to require two, three, four, or even more operations.

 

Stop Smoking: Perhaps the best way to reduce the risk of recurrence of Crohn's disease after surgery is not to smoke cigarettes. Although it has not be proven that for smokers who quit after surgery the risk of recurrent disease is lower, it has been shown that smokers tend to have earlier and more severe recurrences after surgery. So, if you don't already smoke, don't start after surgery, and if you do smoke, consider attempting to quit. Not only will this benefit your Crohn's disease, but it will have other health benefits (reduced heart disease, lower cancer risk, less lung disease).

 

Medications: Some patients, particularly those who have had a very short segment of intestine removed or who had disease for many years before coming to surgery, may choose not to take medication following surgery. For some patients, one goal in undergoing surgery is to stop medication, and this needs to be considered in discussing the management of Crohn's disease after surgery.

 

Although the 5-ASA medications are probably the safest and best tolerated, they have a very modest effect on the risk of recurrence, reducing the risk of recurrence by about 10% to 12%. Metronidazole and other related antibiotics also appear to reduce recurrence, but not all patients are able to tolerate the medications because of a metallic taste in the mouth and gastrointestinal upset. It is not clear if the beneficial effect of antibiotics extends past 1 year after surgery.

 

The immunosuppressants, azathioprine and 6-mercapto-purine, are being used more often for prevention of recurrence after surgery for Crohn's disease, despite the fact that the evidence supporting their use is not entirely clear. Nevertheless, there is a sense among expert IBD physicians that these drugs are among the best maintenance treatments available and, if monitored properly, have good safety records. These drugs are used particularly when a person has had very severe or complicated disease prior to surgery, if a relatively long length of intestine has been surgically removed, or if it is not the first operation for Crohn's disease.

 

Infliximab has been shown to be effective for the treatment of acute flares of Crohn's disease as well as maintenance therapy. Because of its effectiveness in those situations, there has also been interest in using infliximab after surgery. Although there is no evidence yet to say whether or not infliximab is effective after surgery to prevent recurrence, studies are ongoing to determine if infliximab is effective and safe in that setting.