Management of Crohn's Disease After Surgical Resection Guideline Patient Companion

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other healthcare professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand the AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: Management of Crohn’s Disease After Surgical Resection

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

What is Crohn's Disease?

  • Crohn’s disease is a form of inflammatory bowel disease, or IBD.
  • In a person with IBD, the immune system hurts the digestive tract, causing pain and digestion issues.
  • Symptoms:
    • Belly pain.
    • Diarrhea (loose stool).
    • Rectal bleeding.
    • Loss of appetite.
    • Losing weight without meaning to.
    • Non-digestive issues:
      • Skin rash.
      • Red, swollen eyes.
      • Arthritis (painful, swollen joints).
      • Fatigue (tired or weak).
  • Not treating Crohn’s disease can lead to problems, such as:
    • Malnutrition (not being able to eat or take in enough food to stay healthy)
    • Painful ulcers of the mouth, digestive tract, or anus.
    • Leaky holes in the digestive tract leading to bad infections.
    • Low iron or other vitamins.
    • Colorectal cancer.
    • Osteoporosis (weak or brittle bones).
    • Narrowing of the bowels, which can lead to a block.
  • Crohn’s disease is a life-long health issue.
  • Up to half a million Americans have Crohn’s disease.

Surgery for Crohn's Disease

  • Nearly half of patients with Crohn’s disease will need surgery within the first ten years of the disease.
  • The surgery, called a bowel resection, is the removal of parts of the bowels that have been damaged by the inflammation from Crohn’s.
  • Removing the diseased areas of the bowels can reduce pain and greatly improve quality of life.
  • Patients who have already had one surgery for their Crohn’s disease are also at risk for needing surgery in the future. In fact, about one-quarter of Crohn’s patients who had one surgery will need another one within five years.
  • This happens when the patient has a recurrence, or a return of the disease.
  • Certain factors may make recurrence more likely. These include:
    • Smoking cigarettes.
    • Having multiple bowel resections in the past.
    • Penetrating Crohn’s disease. This is when an abnormal passageway, called a fistula, forms inside the body. A fistula may grow between two different parts of the intestine. It may also grow between the intestines and other organs such as the bladder or skin. About one in every three people with Crohn’s will have a fistula at some point.

To learn more about the different surgeries for the treatment of Crohn’s disease, click here.

How to Keep Crohn's Under Control After Surgery

After surgery, there are ways to prevent recurrence and the need for future surgeries. Choices will depend on personal values, preferences, and medical history. Talk to your doctor to find the best option for you and to find out if you have a high-risk or low-risk for recurrence of your Crohn’s disease, as that can guide your decision.

Drug Therapy
  • After your first surgery for Crohn’s disease, your doctor may decide to put you on long-term drug therapy, as drug therapies can help prevent recurrence.
    • High-risk patients should consider drug therapy to prevent recurrence.
  • Examples of drugs that can help prevent recurrence include:
    • Anti-TNF-alpha drugs (part of a family of drugs called biologics).
    • Thiopurines.
    • Nitroimidazole, a type of antibiotic.
  • Anti-TNF-alpha drugs and thiopurines are most effective at reducing recurrence.
    • Taking these drugs after surgery can reduce your risk of recurrence by up to 65 percent.
    • Possible side effects of these drugs may include:
      • Bacterial or fungal infections.
      • Nausea and vomiting.
  • Patients with a lower risk of recurrence may choose to take nitroimidazole to keep their Crohn’s under control after surgery.
  • Nitroimidazole is not as effective as other drugs for preventing recurrence. It may also lead to some neurological symptoms, such as numbing and tingling in the hands and feet, if taken for long periods of time.

Read more about drug therapy options for Crohn’s Disease.

  • Routine colonoscopy will help your doctor catch recurrence early.
  • Even if you are taking drugs to prevent recurrence, AGA suggests seeing your doctor within six to 12 months after surgery for a colonoscopy.
    • This is because signs of recurrence show up on a colonoscopy before you begin to feel symptoms (also known as a “silent” recurrence).
    • Getting a colonoscopy can help your doctor catch any signs of recurrence before your symptoms come back.
  • If there are signs of recurrence, your doctor may choose to increase or change the drugs you are taking. This will give you a better chance of staying healthy and avoiding future surgery.
  • Patients who want to avoid drug therapy should still have routine colonoscopy.
    • Some patients who are not at a high risk for recurrence may choose not to take preventive drug therapy.
    • If you choose this option, AGA strongly recommends that you get a colonoscopy every six to 12 months to watch for signs of recurrence.
    • Your doctor may see signs of recurrence during your colonoscopy even you may not have any symptoms yet.
    • If this happens, your doctor will let you know about your options for starting drug therapy to prevent further damage and to help you avoid future surgery.