Post-operative recurrence in Crohn's disease. Critical analysis of potential risk factors. An update.

Abstract: INTRODUCTION: Crohn's disease is associated with high rates of postoperative recurrence. At 10 years after surgery a high percentage of patients suffer recurrence (as many as 75% and above) and many of these (up to 45%) require a re-intervention. The aim of the study was to identify, among the various "potentially predictive factors", those which, today, should be considered "real risk factors" for postoperative recurrence. METHODS: A review of the literature of the last 30 years was carried out. A medical literature search was conducted using Medline, Embase, Ovid Journals, Science Direct, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Potential risk factors related to the patient, to the disease, to the type of surgery and to the pharmacological treatment were analyzed. RESULTS: Predictive factors, in addition to smoking, are also, in according to the most of Authors, extent more than 100 cm and the absence of postoperative pharmacological treatment. Moreover, in according to "the second European evidence-based Consensus on the diagnosis and the management of Crohn's disease: Special situations", the localization of the disease in the colon, penetrating disease behavior, extensive small bowel resection and the prior intestinal surgery should be considered predictive factors. CONCLUSIONS: The high incidence of postoperative recurrence in Crohn's disease mandates a strict follow up (clinical, laboratory and instrumental monitoring). Identifying patients at increased risk would enable physicians to plane a surveillance program and to implement a rational therapeutic prophylaxis.