Department Chairman Cleveland Clinic Lerner College of Medicine Cleveland, Ohio
Postoperative Crohn's disease recurrence is common and often clinically silent. Risk factors that predict a higher chance of postoperative recurrence include multiple surgeries and penetrating disease. The only modifiable postoperative risk factor is cigarette smoking. Although antibiotics, eg metronidazole, may be effective, for high risk for recurrence patients, the biologics, specifically infliximab (and maybe adalimumab) have the most evidence. Monitoring for recurrence after surgery includes the (gold standard) ileocolonoscopy at 6 months, but also may include fecal calprotectin and small bowel ultrasound.