A recent NASPGHAN clinical report (JB Splawski et al JPGN 2017; 65: 475-86) updates recommendations to lower the rate of postoperative recurrence in pediatric Crohn Disease (CD). In this report, after review of a number of studies, the authors provide a management algorithm (Figure 1). In addition, they review risk factors for surgery/postoperative recurrence in CD.
Key points:
- “Endoscopic recurrence precedes clinical recurrence, and is a better predictor of the risk for future surgery.”
- “Anti-TNF agents appear to be the most effective treatment in preventing postoperative recurrence.” These agents “can be started as early as 4 weeks after surgery.”
- “Prophylactic treatment to prevent recurrence rather than treating after the disease recurs, appears to be more effective in preventing further surgery.”
- “Early postoperative surveillance for disease recurrence allows for a change in management to prevent complications that may lead to further surgery.” The authors note that fecal calprotectin (and lactoferrin) return to baseline around 2 months after surgery, and “monitoring disease activity postsurgery with these tests may help determine appropriate selection for more invasive testing such as endoscopy.”
My take: The authors emphasize that “whatever treatment is chosen, early surveillance for disease recurrence is clearly needed.” In addition, anti-TNF agents are most likely to lower risk of further surgery.
Related blog posts:
- NASGHAN17 Postgraduate Course: Postoperative Crohn’s Disease, Therapeutic Drug Monitoring
- Two Viewpoints: Anti-TNF Therapy for Postoperative Crohn’s Disease
- AGA 2017 Guidelines for Postoperative Crohn’s Disease
- IBD Shorts and Pediatric Postoperative Crohn’s Disease
- Pediatric Consensus Statement: Perianal Crohn Disease …
- Paris Classification of Pediatric Crohn’s Disease | gutsandgrowth
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