Document Detail

Diagnosis, prevention and treatment of postoperative Crohn's disease recurrence.
MedLine Citation:
PMID:  22265329     Owner:  NLM     Status:  MEDLINE    
Ileocolonoscopy remains the gold standard in diagnosing postoperative recurrence. After excluding stricture, wireless capsule endoscopy seemed accurate in small series, but no validated score is available. Ultrasonography is a non-invasive diagnostic method reducing radiation exposure and emerging as an alternative tool for identifying post-operative recurrence. Computed tomography enteroclysis yields objective morphologic criteria that help differentiate between recurrent disease and fibrostenosis at the anastomotic site, but ionising radiation exposure limits its use. Magnetic resonance imaging may be as powerful as ileocolonoscopy in diagnosing postoperative recurrence and in predicting the clinical outcome using specific MR-scores. Biomarkers such as faecal calprotectin and faecal lactoferrin showed promising results, but their specificity in the postoperative period will require further investigation. Numerous medications have been tested to prevent and/or to treat postoperative recurrence. Efficacy of mesalamine is very low and comparable to placebo in most series. Thiopurines have modest efficacy in the postoperative setting and are associated with a high rate of adverse events leading to drug withdrawal. Antibiotics such as metronidazole or ornidazole may be effective, but toxicity and drug resistance prevent their long-term use. Anti-Tumour Necrosis Factor therapy is the most potent drug class to prevent and to treat postoperative recurrence in Crohn's disease.
Anthony Buisson; Jean-Baptiste Chevaux; Gilles Bommelaer; Laurent Peyrin-Biroulet
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-01-20
Journal Detail:
Title:  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver     Volume:  44     ISSN:  1878-3562     ISO Abbreviation:  Dig Liver Dis     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-04-27     Completed Date:  2012-09-07     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  100958385     Medline TA:  Dig Liver Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  453-60     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Auvergne University, Clermont-Ferrand, France.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Antibodies, Monoclonal / therapeutic use
Antibodies, Monoclonal, Humanized / therapeutic use
Azathioprine / therapeutic use
Biological Markers
Capsule Endoscopy
Crohn Disease / diagnosis*,  prevention & control,  therapy*
Enteral Nutrition
Immunosuppressive Agents / therapeutic use
Magnetic Resonance Imaging
Mesalamine / therapeutic use
Recurrence / prevention & control
Sulfasalazine / therapeutic use
Tomography, X-Ray Computed
Tumor Necrosis Factor-alpha / antagonists & inhibitors
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Biological Markers; 0/Immunosuppressive Agents; 0/Tumor Necrosis Factor-alpha; 0/infliximab; 446-86-6/Azathioprine; 599-79-1/Sulfasalazine; 89-57-6/Mesalamine; FYS6T7F842/adalimumab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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