Talk to just about anyone with Crohn's disease and it's likely that they have had surgery. Approximately 75 percent of Crohn's disease patients who have disease in the small bowel will have surgery in the first 10 years after diagnosis. Resections to remove diseased tissue are common, and may be repeated as the disease recurs in different sections of the intestine. Crohn's can cause narrowing of the bowel, also called a stricture, which may require strictureplasty. Complications from Crohn's such as abscesses or fissures can also require surgery.
Unfortunately, several studies show that Crohn's often returns after surgery in 3 to 4 years for about 50 percent of patients. When it returns depends on several factors.
One study shows that women have a "significantly" higher rate of relapse after surgery than men. Other factors increasing the rate of relapse include peri-anal fistulas and disease located only in the small bowel. The good news is that neither a patient's age, nor the length of time since diagnosis had any affect on the rate of relapse in this study.
Children with Crohn's disease face similar hurdles. In the first five years of diagnosis, about 50 percent of children will need surgery.
There is hope on the horizon to break the cycle of surgery and relapse. New research is aimed at slowing this rate of relapse after surgery. One study sought to lower the rate of relapse by using medication. When given mesalamine after surgery, patients had only a 31.5 percent chance of relapse (compared to the 50 percent referenced above). Metronidazole has also been studied for use after surgery, but is not as effective in preventing relapses after 3 years.
Research is going forward in the treatment of Crohn's disease. Other drugs are also being studied for their role in preventing relapse after surgery. Some medications, such as Remicade (Infliximab) show promise in reducing the initial need for surgery. In the meantime, IBD patients can use the tips below to help prevent relapses.
Tips to prevent relapses:- Take medication regularly as prescribed. If you need help remembering, see 8 Tips for Keeping Track of Your Medications for ideas.
- Stop smoking: Smoking is an irritant, and has been linked to relapses of Crohn's disease. If you need help, see Smoking Cessation Guide Terry Martin and visit her forum.
- Avoid NSAIDs: This group of drugs (which includes aspirin) can bring on a relapse.
Sources:
Bernell O, et al. "Risk factors for surgery and postoperative recurrence in Crohn's disease." Ann Surg January 2000;231:38-45.
P Rutgeerts, M Hiele, K Geboes, M Peeters, F Penninckx, R Aerts, and R Kerremans. "Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection." Gastroenterology 108:1617-1621.
