S. Vermiere et P. Rutgeerts, MEDICINAL PROPHYLAXIS OF RECURRENCE OF CR OHNS-DISEASE IN THE NEOTERMINAL ILEUM AFTER ILEAL RESECTION, Zentralblatt fur Chirurgie, 123(4), 1998, pp. 352-356
Crohn's recurrence is the appearance of objective signs defined define
d radiologically, endoscopically or pathologically of Crohn's disease
in the bowel of a patient who has previously had a resection of all ma
croscopically diseased tissue. New lesions can be visualized endoscopi
cally within weeks to months after ileal resection and ileocolonic ana
stomosis in the neoterminal ileum. The evolution of these lesions mimi
cs the natural history of ileal Crohn's disease at the onset. If we ar
e able to prevent recurrence of early lesions we would probably interr
upt the natural course of the disease. The drugs tested until today in
clude different 5-ASA formulations, metronidazole and budesonide. 5-AS
A seems to have a limited protective effect. High dose metronidazole s
tarted immediately after surgery decreases endoscopic and symptomatic
recurrence rates but is associated with a lot of side effects. Budeson
ide 6 mg/day o.m. reduces endoscopic recurrence after one year only in
patients operated upon for inflammatory activity. Studies with immuno
suppression for recurrence prevention are currently underway. Thus, to
day 5-ASA-formulations are recommended as general pharm aco-prophylaxi
s.