|
1
|
Olteanu AO, Klimko A, Tieranu EN, Bota AD, Preda CM, Tieranu I, Pavel C, Pahomeanu MR, Toma CV, Saftoiu A, Ionescu EM, Tieranu CG. Managing Crohn's Disease Postoperative Recurrence Beyond Prophylaxis: A Comprehensive Review with Meta-Analysis. Biomedicines 2024; 12:2434. [PMID: 39595001 PMCID: PMC11591769 DOI: 10.3390/biomedicines12112434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 10/14/2024] [Accepted: 10/19/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND AND AIMS Postoperative recurrence in Crohn's disease remains a significant clinical challenge, with high recurrence rates despite advancements in medical therapy. This study aims to evaluate the efficacy of various treatments for managing postoperative recurrence following ileocolonic resection in Crohn's disease. METHODS A comprehensive search of PubMed, Cochrane, and Scopus databases was performed to identify studies reporting on the therapeutic management of postoperative recurrence in Crohn's disease. Studies encompassing patients with an endoscopic Rutgeerts score of at least I2 were included. RESULTS Ustekinumab showed promise, achieving significant endoscopic and clinical success in difficult-to-treat patients. Anti-TNF agents demonstrated superior endoscopic and clinical remission rates compared to mesalamine and azathioprine. Retreatment with anti-TNF therapy remained effective even after preoperative failure. Thalidomide showed efficacy in refractory Crohn's disease, but carries significant toxicity risks, necessitating careful patient selection and monitoring. Combination therapies and non-pharmacologic strategies like enteral nutrition offer additional options, though patient compliance remains challenging. CONCLUSIONS Personalized treatment plans based on individual risk factors and biomarkers are crucial. Infliximab is recommended as the first-line treatment, with ustekinumab and vedolizumab as alternatives in case of anti-TNF failure or intolerance. Early intervention, patient education, and ongoing evaluation are essential for optimizing long-term outcomes in managing postoperative recurrence in Crohn's disease.
Collapse
Affiliation(s)
- Andrei Ovidiu Olteanu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, ELIAS Emergency University Hospital, 011461 Bucharest, Romania
| | - Artsiom Klimko
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Eugen Nicolae Tieranu
- Department of Cardiology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Andreea Daniela Bota
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, ELIAS Emergency University Hospital, 011461 Bucharest, Romania
| | - Carmen Monica Preda
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ioana Tieranu
- Department of Pediatrics, “Marie Sklodowska Curie” Children Emergency Hospital, 077120 Bucharest, Romania
| | - Christopher Pavel
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, Clinical Emergency University Hospital, 014461 Bucharest, Romania
| | - Mihai Radu Pahomeanu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Internal Medicine and Gastroenterology, Bucharest Emergency University Hospital, 050098 Bucharest, Romania
| | - Cristian Valentin Toma
- Department of Innovation and e-Health, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Adrian Saftoiu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, ELIAS Emergency University Hospital, 011461 Bucharest, Romania
| | - Elena Mirela Ionescu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, ELIAS Emergency University Hospital, 011461 Bucharest, Romania
| | - Cristian George Tieranu
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.O.O.); (C.M.P.); (C.P.); (A.S.); (E.M.I.); (C.G.T.)
- Department of Gastroenterology, ELIAS Emergency University Hospital, 011461 Bucharest, Romania
| |
Collapse
|
|
2
|
Bachour SP, Click BH. Clinical Update on the Prevention and Management of Postoperative Crohn's Disease Recurrence. Curr Gastroenterol Rep 2024; 26:41-52. [PMID: 38227128 DOI: 10.1007/s11894-023-00911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW Despite advances in therapeutics, a significant portion of patients with Crohn's disease still require surgical management. In this article, we present updates to the natural history, prognostication and postoperative monitoring, and novel therapeutics in the prevention and treatment of postoperative Crohn's disease recurrence. RECENT FINDINGS Clinical risk factors have been associated with higher rates of postoperative recurrence (POR), and in recent studies demonstrate an increased cumulative risk with presence of additional risk factors. Additional novel clinical, histologic, and "-omic" risk factors for recurrence have recently been elucidated, including the role of the mesentery on recurrence and perioperative intraabdominal septic complications. High-risk patients benefit most from medical prophylaxis, including anti-TNF with or without immunomodulator therapy to prevent recurrence. New biologics such as vedolizumab and ustekinumab have emerging evidence in the use of prophylaxis, especially with recent REPREVIO trial data. Non-invasive disease monitoring, such as cross-sectional enterography, intestinal ultrasound, and fecal calprotectin, have been validated against ileocolonoscopy. Recent advances in the prediction, prevention, and monitoring algorithms of postoperative Crohn's disease may be leading to a reduction in postoperative recurrence. Ongoing trials will help determine optimal monitoring and management strategies for this at-risk population.
Collapse
Affiliation(s)
- Salam P Bachour
- Brigham and Women's Hospital, Department of Medicine, Boston, MA, 02115, USA
| | - Benjamin H Click
- University of Colorado Anschutz Medical Campus, Division of Gastroenterology and Hepatology, 13001 E 17th Pl, Aurora, CO, 80045, USA.
| |
Collapse
|