Overview
Crohn's disease (CD) can affect any part of the gastrointestinal tract, including anastomoses created after surgical resection 1. Anastomotic recurrence is a common complication following surgery for CD 1.Diagnosis
Endoscopic evaluation with biopsies is the gold standard for diagnosing anastomotic recurrence 1.
Small bowel imaging (e.g., MRI enterography, CT enterography) can also detect anastomotic inflammation 1.
Histological examination of biopsies should assess for transmural inflammation, crypt abscesses, and granulomas characteristic of CD 1.Management
Medical therapy is recommended for symptomatic anastomotic recurrence or in high-risk patients 1.
First-line medical therapy often involves 5-aminosalicylic acid (5-ASA) agents, although their efficacy in preventing recurrence is debated 1.
Immunomodulators (e.g., azathioprine, methotrexate) are used for steroid-dependent or steroid-refractory recurrence 1.
Biologic agents, particularly anti-tumor necrosis factor (TNF) agents, are highly effective for managing symptomatic anastomotic recurrence 1.
Antibiotics may be used for specific complications like abscesses 1.Key Recommendations
Medical therapy should be considered for symptomatic anastomotic recurrence or in patients at high risk for recurrence 1. (Evidence: Strong)
Anti-TNF agents are recommended for the treatment of symptomatic anastomotic recurrence 1. (Evidence: Strong)
Prophylactic medical therapy (e.g., 5-ASA, immunomodulators, or biologics) may be considered in select high-risk patients after resection to prevent recurrence 1. (Evidence: Moderate)References
1 Adamina M, Minozzi S, Warusavitarne J, Buskens CJ, Chaparro M, Verstockt B et al.. ECCO Guidelines on Therapeutics in Crohn's Disease: Surgical Treatment. Journal of Crohn's & colitis 2024. link