Postsurgical Recurrence of Ileal Crohn’s Disease: An Update on Risk Factors and Intervention Points to a Central Role for Impaired Host-Microflora Homeostasis

摘要: A pressing need exists to identify factors that predispose recurrence after terminal ileal resection for Crohn’s disease (CD) and determine effective prophylactic strategies. This review presents an up-to-date summary of the literature in field points a role bacterial overproliferation recurrence. The (Medline, Embase, Cochrane Library, 1971–2009) on CD postoperative was searched, 528 relevant articles were identified reviewed. Smoking is key independent risk factor NOD2/CARD15 polymorphisms penetrating phenotype are associated with aggressive higher reoperation rates. Age at diagnosis, duration, gender, family history inconsistent predictors Prophylactic 5-aminosalicylic acid therapy nitromidazole antibiotics beneficial. Combination therapies immunosuppressants also effective. Anti-TNFα-based regimens show benefit but evidence base small. Corticosteroid, interleukin-10, probiotic not Wider, stapled anastomotic configurations reduced Strictureplasty laparoscopic approaches have similar long-term rates open techniques. Length presence microscopic margins do influence lack consensus regarding whether granulomas or plexitis affects outcome. Current defects mucosal immunity intestinal dysbiosis either innate (NOD2/CARD15) induced (smoking) origin strategies should aim limit (antibiotics, side-to-side anastomoses) prevent downstream chronic inflammatory sequelae (anti-inflammatory, immunosuppressive, immunomodulatory therapy).