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Is medical prophylaxis indicated for the prevention of recurrence of Crohn's disease after surgery?

Surgery is an accepted and important modality in the treatment of patients with Crohn's disease. It is generally reserved for patients who have failed all medical treatments or have developed complications of the disease. Results are often dramatic as obstructive symptoms are relieved, fistulae and other septic complications are eliminated, and nutritional status is improved. As a result, physical well-being is usually restored and quality of life improved. Unfortunately, although there are many beneficial effects of surgery, they may, at least in part, be negated by the risk of recurrent disease. Variable recurrence rates have been reported depending on the criteria used to define recurrence, the method of analysis, and the characteristics of the study population. Although endoscopic rates of >70% at 1 year have been reported, the significance of this is unknown, and the clinical or symptomatic recurrence rate is probably of more clinical relevance. In a cohort of patients followed prospectively by our group, the clinical recurrence rate was 17% at 1 year and 45% at 3 years (1). Others have reported rates of 22-59% at 5 years (2). There are