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Pathogenesis of postoperative recurrence in Crohn's disease
  1. Tasneem Ahmed1,
  2. Florian Rieder2,
  3. Claudio Fiocchi1,2,
  4. Jean-Paul Achkar1,2
  1. 1Department of Gastroenterology, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Jean-Paul Achkar, Cleveland Clinic, Desk A31, 9500 Euclid Avenue, Cleveland, OH 44195, USA; achkarj{at}


The majority of patients with Crohn's disease (CD) require surgery during the course of their disease, but such surgery is typically not curative. Although some studies suggest that the disease state is theoretically reset to its earliest phase following surgery, disease phenotype and natural history of CD do not change significantly after surgery, leading to high rates of recurrence. Factors predisposing to this recurrence are not well defined, so there is a need for and a unique opportunity to develop a better understanding of the pathogenesis of recurrent inflammation and associated risk factors after an ileocolic resection. This paper reviews the postoperative disease outcome and evolution based on defining the combination of the patient's microbial flora, environmental exposure history, immune response and genetic make-up.

  • Crohn's
  • postoperative
  • recurrence
  • pathogenesis
  • risk factors
  • bacterial interactions
  • crohn's disease
  • genetics
  • immune response

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.