Di Sario Antonio, Sassaroli Paola, Daretti Luigi, Annulli Giulia, Schiada Laura, Falcioni Giorgia, Bendia Emanuele, Antuono Simone, Benedetti Antonio
Clinic of Gastroenterology and Hepatology and #Dermatological Unit, Ospedali Riuniti University Hospital, Via Conca 71, 60126 Ancona, Italy.
Curr Pharm Biotechnol. 2017;18(12):979-988. doi: 10.2174/1389201019666180216152805.
Abstract: Up to 80% of Crohn's disease (CD) patients require at least one surgical intervention in their lifetime and up to 70% of these patients develop postoperative endoscopic recurrence within 1 year.
The most important predictors of early postoperative recurrence are represented by smoking, prior intestinal surgery, penetrating disease and perianal location. Genetic factors, gut microbiota structure and immunological alterations may be involved in the pathogenesis of postoperative recurrence of CD, although their specific roles have to be determined yet.
Different drugs, such as metronidazole, thiopurines and anti-tumor necrosis factor α (anti- TNFα) have been shown to reduce the risk of recurrence in many clinical trials, although the choice of the drug should take into consideration the benefits, the potential side effects and also the costs. Patients who are at high risk for postoperative recurrence should be considered for early medical prophylaxis with thiopurines or anti-TNFα drugs; on the contrary, patients who do not have risk factors may receive no treatment or receive a course of antibiotic or mesalazine followed by tailored therapy based on endoscopy at 6 months.
Therefore, stratifying patients according to their risk of recurrence and tailoring therapy are at present the ideal and most cost-effective ways to treat operated CD patients, although many aspects require further evaluation.
摘要：高达80%的克罗恩病（CD）患者一生中至少需要接受一次手术干预，其中高达70%的患者在术后1年内出现内镜复发。
术后早期复发的最重要预测因素包括吸烟、既往肠道手术史、穿透性病变和肛周病变部位。遗传因素、肠道微生物群结构和免疫改变可能参与了CD术后复发的发病机制，尽管它们的具体作用尚待确定。
在许多临床试验中，不同药物，如甲硝唑、硫唑嘌呤和抗肿瘤坏死因子α（抗TNFα）已被证明可降低复发风险，尽管药物的选择应考虑其益处、潜在副作用以及成本。术后复发高危患者应考虑早期使用硫唑嘌呤或抗TNFα药物进行药物预防；相反，无危险因素的患者可能无需治疗，或接受一个疗程的抗生素或美沙拉嗪治疗，随后在6个月时根据内镜检查结果进行个体化治疗。
因此，根据复发风险对患者进行分层并进行个体化治疗是目前治疗CD手术患者的理想且最具成本效益的方法，尽管许多方面仍需进一步评估。
