Management of Crohn’s Disease After Surgical Resection
Publication Date: January 2, 2017
Last Updated: December 16, 2022
Management
Recommendations for the Management of Crohn’s Disease After Surgical Resection
In patients with surgically induced remission of CD, AGA suggests early pharmacological prophylaxis over endoscopy-guided pharmacological treatment. ( Very Low , Conditional (weak) )
Comments: Patients, particularly those at lower risk of recurrence, who place a higher value on avoiding the small risks of adverse events from pharmacological prophylaxis and a lower value on the potential risk of early disease recurrence may reasonably select endoscopy-guided pharmacological treatment over prophylaxis.
612
In patients with surgically induced remission of CD, AGA suggests using anti-TNF therapy and/or thiopurines over other agents. ( Moderate , Conditional (weak) )
Comments: Patients at lower risk of disease recurrence or who place a higher value on avoiding the small risk of adverse events of thiopurines or anti-TNF treatment and a lower value on a modestly increased risk of disease recurrence may reasonably choose nitroimidazole antibiotics (for 3–12 months).
612
In patients with surgically induced remission of CD, AGA suggests against using mesalamine (or other 5-aminosalicylates), budesonide, or probiotics. ( Very Low , Conditional (weak) )
612
In patients with surgically induced remission of CD receiving pharmacological prophylaxis, AGA suggests postoperative endoscopic monitoring at 6–12 months after surgical resection over no monitoring. ( Moderate , Conditional (weak) )
612
In patients with surgically induced remission of CD not receiving pharmacological prophylaxis, AGA recommends postoperative endoscopic monitoring at 6–12 months after surgical resection over no monitoring. ( Moderate , Strong )
612
In patients with surgically induced remission of CD with asymptomatic endoscopic recurrence, AGA suggests initiating or optimizing anti-TNF and/or thiopurine therapy over continued monitoring alone. ( Moderate , Conditional (weak) )
Comments: Patients who place a higher value on avoiding the small risk of adverse events of thiopurines or anti-TNF treatment and a lower value on the increased risk of clinical recurrence following asymptomatic endoscopic recurrence may reasonably choose continued endoscopic monitoring.
612
Title
Management of Crohn’s Disease After Surgical Resection
Authoring Organization
American Gastroenterological Association
Publication Month/Year
January 2, 2017
Last Updated Month/Year
November 6, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
Outline strategies to reduce disease recurrence in patients who have achieved remission following bowel resection. These recommendations address the role of postoperative pharmacological prophylaxis and endoscopic monitoring in patients with an ileocolonic anastomosis who are asymptomatic without macroscopic evidence of CD after surgical resection.
Target Patient Population
Patients with an ileocolonic anastomosis who are asymptomatic without macroscopic evidence of crohn's disease (CD) after surgical resection.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Diseases/Conditions (MeSH)
D003424 - Crohn Disease
Keywords
inflammatory bowel disease, Crohn's disease, IBD, CD
Source Citation
Nguyen GC, Loftus EV Jr, Hirano I, Falck-Ytter Y, Singh S, Sultan S; AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Management of Crohn's Disease After Surgical Resection. Gastroenterology. 2017 Jan;152(1): 271-275.