Postoperative maintenance therapy for inflammatory bowel disease

. Curr Opin Gastroenterol. 2006 Jul;22(4):377-81.Postoperative maintenance therapy for inflammatory bowel disease.Cottone M, Orlando A, Modesto I.Department of General Medicine, Pneumology and Nutrition Clinic, PalermoUniversity, Palermo, Italy.PURPOSE OF REVIEW: This review will highlight the knowledge gained from studiespublished in the year 2005 on maintenance treatment after surgery forinflammatory bowel diseases.RECENT FINDINGS: In Crohn's disease the role of smoking in increasing the risk ofrelapse and recurrence after surgery is confirmed. Ornidazole seems effective in reducing endoscopic recurrence and clinical relapse after surgery. Probiotics do not appear to be effective in preventing endoscopic recurrence and clinicalrelapse: a controlled placebo trial showed that Lactobacillus johnsonii is noteffective in preventing endoscopic recurrence. A retrospective study suggestedthat enteral nutrition after surgery may reduce the clinical relapse.Pathophysiological studies underlined the value of probiotics in pouchitis.SUMMARY: In Crohn's disease postoperative maintenance treatment is disappointing.Giving up smoking is still the only effective measure. Mesalamine remains thedrug that has been widely studied with large trials and meta-analysis.Encouraging results come from small trials on antibiotics. Azathioprine and6-mercaptopurine must be evaluated in better designed controlled trials. There isno evidence in favour of probiotics as an effective therapy to preventrecurrence. Enteral nutrition after surgery is a candidate new therapy, butfurther controlled trials are needed. Pathophysiological studies confirm thebeneficial role of probiotics in pouchitis.