Recurrence of Crohn's disease in the neoterminal ileum after ileal resection: is prevention therapy possible?

Crohn's recurrence is the appearance of objective signs--defined radiologically, endoscopically or pathologically--of Crohn's disease in the bowel of a patient who has previously had a resection of all macroscopically diseased tissue. New lesions can be visualized endoscopically within weeks to months after ileal resection and ileocolonic anastomosis in the neoterminal ileum. The evolution of these lesions mimics the natural history of ileal Crohn's disease at the onset. If we are able to prevent recurrence of early lesions, we could probably interrupt the natural course of the disease. Metronidazole decreases the severity of early recurrence without totally preventing it. The data on 5-ASA are conflicting. Claversal seems to have little effect whereas Asacol was found to prevent not only endoscopic but also clinical recurrence. Pentasa prevented the development of severe recurrence. New therapies including topically acting glucocorticosteroids and immune suppression should be studied.