Introduction

Crohn's disease (CD) is a chronic inflammatory bowel disease with no known cure. Since its first description, its nature has remained relapsing [1], and continues to be a clinical challenge due to the variability of its presentation and complex pathophysiology. Its prevalence is affected by the distance from the equator and its incidence has slowly increased. [2]. Crohn's disease has an incidence of 2-5/1 000, and causes significant morbidity and health care expense for Western countries [3].

One unanswered dilemma in the management of patients with CD, is the role of treatment in the postoperative period. When followed up long-term, more than three quarters of patients with CD will require surgery [4] Postoperatively, disease recurrence is common and a high proportion of those patients will require reoperation [3-5]. Despite the availability of newer therapies and the fact that up to 57% of patients may require further surgery within 10 years, there is a lack of evidence to show that medical therapy can reduce relapse.

Research into the maintenance of remission has been hampered by many factors. Firstly, there is not a universal definition for disease recurrence, and although there are studies reporting on histological, clinical, radiological and endoscopic criteria in an effort to define recurrence, their correlation is often imperfect [6-8]. Secondly, validated CD assessment tools are often not appropriate for use in the postoperative period. Thirdly, disease incidence can vary due to the geography of large units around the world and also differing patient-care pathways, and finally animal models in examining the postoperative period can be labour intensive and expensive and therefore often not feasible [4].

The purpose of this chapter is to review the literature on the various influences on the postoperative recurrence of CD.

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