Management
Recommendations for the Management of Crohn's Disease
After Surgical Resection
Statement
Strength of
recommendation
Quality of
evidence
In patients with surgically induced remission of CD,
AGA suggests early pharmacological prophylaxis over
endoscopy-guided pharmacological treatment.
Comments: Patients, particularly those at lower
risk of recurrence, who place a higher value on
avoiding the small risks of adverse events from
pharmacological prophylaxis and a lower value
on the potential risk of early disease recurrence
may reasonably select endoscopy-guided
pharmacological treatment over prophylaxis.
Conditional Very low
quality
In patients with surgically induced remission of
CD, AGA suggests using anti-TNF therapy and/or
thiopurines over other agents.
Comments: Patients at lower risk of disease
recurrence or who place a higher value on avoiding
the small risk of adverse events of thiopurines or
anti-TNF treatment and a lower value on a modestly
increased risk of disease recurrence may reasonably
choose nitroimidazole antibiotics (for 3–12 months).
Conditional Moderate
In patients with surgically induced remission of CD,
AGA suggests against using mesalamine (or other
5-aminosalicylates), budesonide, or probiotics.
Conditional Low;
very low
In patients with surgically induced remission of CD
receiving pharmacological prophylaxis, AGA suggests
postoperative endoscopic monitoring at 6–12 months
aer surgical resection over no monitoring.
Conditional Moderate
In patients with surgically induced remission of CD
not receiving pharmacological prophylaxis, AGA
recommends postoperative endoscopic monitoring
at 6–12 months aer surgical resection over no
monitoring.
Strong Moderate
In patients with surgically induced remission of CD
with asymptomatic endoscopic recurrence, AGA
suggests initiating or optimizing anti-TNF and/or
thiopurine therapy over continued monitoring alone.
Comments: Patients who place a higher value
on avoiding the small risk of adverse events of
thiopurines or anti-TNF treatment and a lower
value on the increased risk of clinical recurrence
following asymptomatic endoscopic recurrence
may reasonably choose continued endoscopic
monitoring.
Conditional Moderate
