Postsurgical Patients

Prophylactic therapy after resection for CD may prevent recurrence of the disease. However, no clear prophylactic drug regimens have been identified. In the last decade, endoscopic recurrence has been considered a relevant outcome in patients suffering from CD since they are strictly related to the clinical outcome. After surgery, more than 70% of patients at 1 year and more than 85% at 3 years will have an endo-scopic recurrence in the neoterminal ileum [130-134]. Consequently, more than 20% of patients will already have a clinical recurrence within the first year after surgery, with a 10% increase in each subsequent year [135]. The pattern of CD remains unchanged after surgery. Fistulising disease before surgery will have the same complications after resection and early recurrent symptoms [131].

Standard therapy with steroids or 5-ASA formulations are unable to prevent development of new lesions at 1 year after resection whereas nitroimida-zole antibiotics (metronidazole and ornidazole) seem to be effective in preventing endoscopic and clinical recurrences [136, 137]. However, some patients are intolerant to nitroimidazole antibiotics. The benefit of immunosuppression for preventing endoscopic and clinical recurrence is lower than expected yet still high (70% and more than 50%, respectively, at 1 year).

The role of biologic therapy in postsurgical patients is still controversial, and no controlled trials are present in literature. However, aggressive disease, young age and intolerance to standard therapies (steroid dependence; steroid-refractory or immuno-suppressant side effects) may represent an indication for infliximab therapy in the postsurgery period to prevent disease recurrence, as recently suggested [131].

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