Crohn's Post-operative Recurrence

Question 1

What is the 10 year risk of surgical resection for Crohn’s

Answer 1

Approximately 50%

Question 2

What are RF for post operative recurrence

Answer 2

smoking, fistulising/ penetrating disease

Question 3

What is the rate of clinical recurrence at 1 and 3 years

Answer 3

20-40% at 1 yer

30-85% at 3 years

Question 4

Which and when should patients undergo endoscopy post resection

Answer 4

All patients irrespective of post-operative treatment should undergo ileocolonoscopy 6-12 months post resection

Question 5

What should be assessed at post op endoscopy

Answer 5

NeoTI

Rugeert i2 = recurrence and need for medical therapy -> >5 apthous ulcers

i3 = apthous inflammation
i4 = ulcerating inflammation

Question 6

What prophylaxis should patients receive post op

Answer 6

low risk - metronidazole 1-2g/day for 3 months

high risk - Metronidazole + AZA or TNF

metro started when food recommenced

AZA/TNF 2-8 weeks post op