Récidive postopératoire de la maladie de Crohn: facteurs prédictifs et traitement médical d’entretien

Abstract

The majority of patients with Crohn’s disease (CD) require the use of surgical treatment at some point in their evolution. However, disease recurrence is frequent. Some factors may influence the time to recurrence and the severity of symptoms. Knowledge of this risk of recurrence justifies the concept of limiting bowel resection and helps in the discussion of the prophylactic treatment of relapses after surgery. The purpose of this review is to review the risk factors for postoperative recurrence of CD and prophylactic treatment of recurrence. The factors contributing to recurrence after surgery for CD have been evaluated in numerous studies, but controlled studies are rare and the results are sometimes contradictory. The main question is how to prevent recurrence after surgery? Besides the proven role of tobacco (withdrawal should be mandatory), different drugs (sulfasalazine and aminosalicylates, metronidazole, immunosuppressants, probiotics and anti-TNF-alpha) have been tested through several controlled therapeutic trials. Drug candidates would be nitroimidazoles and immunosuppressants, and new therapeutic approaches evaluating better biological therapies should be performed to better elucidate their therapeutic role. The attitudes are clear after ileal or ileo-colic resection, but they are less clear after colonic or colorectal resection.