Medical Management of Post-Operative Crohn's Disease

Nearly one million people in the United States suffer from Crohn's disease (CD), with studies showing increase in the rate of prevalence of CD from 214 per 100,000 people in 2004-2005, to 236 per 100,000 people in 2008-2009.1,2 Crohn's disease (CD) is a chronic immune mediated inflammatory disorder of the gastrointestinal system that can involve anywhere from the mouth to the anus. Over one-half of patients with CD will have an intestinal complication of strictures, fistulas and abscesses(3) and nearly 70% require surgical resections by 15 years.(4) Surgery can induce remission but is not curative, as most patients undergoing an ileo-cecal resection will develop endoscopic recurrence one year after surgery.(5) More importantly, these patients do not manifest symptoms (i.e. they are clinically "silent") until another complication presents and surgery is required. Primary care physicians will often see these patients and it is important to understand the natural course and management of postoperative Crohn's disease.