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Crohn's disease recurrence can be prevented after ileal resection
  1. D S Rampton
  1. Academic Department of Adult and Paediatric Gastroenterology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK
  1. Correspondence to:
    Dr DS Rampton, Endoscopy Unit, Basement, Royal London Hospital, London E1 1BB, UK;
    drampton{at}mds.qmw.ac.uk

https://doi.org/10.1136/gut.51.2.153

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    About half of patients with ileal Crohn's disease have a clinical relapse within five years of a first resection; half will need a second operation by 10 years. The proposal that recurrence can be prevented is clearly untenable as there are no data whatsoever to indicate that any currently available measure can reduce to zero the postoperative relapse rate. However, I will take a less literal interpretation of the motion and review the evidence against the suggestion that the postoperative rate of symptomatic, as opposed to endoscopic, recurrence of ileal Crohn's1 can be reduced by therapeutic interventions.

    STOPPING SMOKING

    There is strong retrospective data that stopping smoking halves the symptomatic recurrence rate up to 10 years after surgery.2,3 Furthermore, although not specifically relating to the postoperative course, a recent prospective trial has confirmed that stopping smoking improves the natural history of Crohn's.4

    AMINOSALICYLATES

    A meta-analysis5 covering four trials6–,9 suggested that long term aminosalicylates slightly reduced the risk of symptomatic relapse after surgery (risk reduction 13%, making the number of patients needing to be treated (NNT) to …

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