Optimal strategies to prevent recrudescent Crohn's disease after resection

Abstract Despite significant advances in new drugs and therapeutic strategies, surgery is still needed in a significant proportion of Crohn's disease (CD) patients. As no medical or surgical cure exists, recurrence after surgical resections is a common scenario in clinical practice. Endoscopic recurrence precedes clinical and surgical recurrences. Thus, the target of disease control after surgery is linked to strategies aiming prevention of postoperative recurrence. Smoking cessation is an important step forward towards reduction of endoscopic recurrence rates. Biological agents are more effective than conventional therapies in postoperative recurrence prophylaxis, and the proper indication of which agent and which dose to use need to be tailored on an individual basis. These agents are mostly indicated in patients with risk factors for recurrence, such as previous resections and penetrating disease. Monitoring patients after surgery in CD with scheduled colonoscopies and biomarkers is essential to optimize therapy whenever needed. In this review, the authors summarize the data on efficacy and limitations of different medical therapies for prevention of endoscopic recurrence. Additionally, the relation of smoking and recurrence, description of how fecal calprotectin fits in treatment algorithms and specific practical issues for advice in proactive strategies aiming CD recurrence prophylaxis are discussed in detail.