Initial approach to medical therapy for Crohn disease after surgical resection

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 i2a are >5 aphthous ulcers confined to the anastomosis, whereas findings consistent with i2b 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.