Initial approach to medical therapy for Crohn disease after surgical resection

This algorithm summarizes the general approach to medical therapy following surgical resection for Crohn disease. This algorithm is intended for use in conjunction with other UpToDate content. Refer to UpToDate content on postsurgical management of Crohn disease including the evidence supporting the efficacy of these therapies.

IL: interleukin; TNF: tumor necrosis factor.

* While individual risk factors may have a different impact on prognosis, most patients can be stratified into higher- and lower-risk groups. Clinical features associated with lower risk of recurrence include long-standing Crohn disease, short stricture, no tobacco use, and no prior surgeries for Crohn disease.

¶ Surgical resection for a fibrotic stricture is not regarded as anti-TNF treatment failure. Patients who undergo resection of fibrotic stricture(s) may resume the same medical regimen after surgery. Refer to UpToDate content on maintenance therapy for Crohn disease for details.

Δ The neoterminal ileum is assessed endoscopically, and a score of i2 or greater indicates recurrence. Endoscopic findings consistent with i2 are >5 aphthous ulcers in the neoterminal ileum with normal intervening mucosa. Refer to UpToDate content on endoscopic scoring systems for additional details.

◊ Measuring fecal lactoferrin is an alternative to fecal calprotectin. We typically measure the stool marker that correlated well with the patient's disease activity preoperatively.

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Initial approach to medical therapy for Crohn disease after surgical resection