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Clin Colon Rectal Surg 2019; 32(04): 225-230
DOI: 10.1055/s-0039-1683853
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tailored Medical Management of the Complex Postoperative Crohn's Disease Patient

Jean-Paul Achkar
1   Kenneth Rainin Endowed Chair for IBD Research, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
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Publication History

Publication Date:
02 July 2019 (online)

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Abstract

Despite advancements in medical therapy, many patients with Crohn's disease continue to require surgery for intestinal resection and/or management of perianal disease at some point in their disease course. Unfortunately, in this complex group of patients, postoperative disease recurrence rates are high. Medical prophylaxis can be used to prevent Crohn's disease recurrence or manage residual disease after surgery, but the ideal timing to start medications after surgery varies based on patient risk factors and patient preference for medication use. Currently, the largest medical treatment effects are seen with thiopurines and antitumor necrosis factor antibodies, but there are continually expanding options as new medical therapies are developed. A proposed algorithm stratified based on patient risk factors is provided.

Keywords

Crohn's disease - postoperative recurrence - thiopurines - antitumor necrosis factor antibodies
 

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