[Therapy of Crohn disease in internal medicine: postoperative recurrence and fistulas].

The recurrence rate of Crohn's disease after surgery is very high. Approx. 30-50% of patients require surgery after the last operation within 1-3 years. While ileal disease in women appears to have the highest rate of relapse, colonic disease seems to have the lowest rate of recurrence. The procedure of surgery had no significant influence, i.e. strictureplasty with or without resection. So far, there are no serological parameters to estimate the risk of relapse for Crohn's disease. Several trials of medical treatment for prevention of recurrence showed a positive effect for mesalazine (2-4 g/d), at least for the maintainance of remission. The medical treatment of fistulas in patients with Crohn's disease consists initially in the combination of cyclosporine, azathioprine and low-dose prednisolone. In the follow-up the remission can be maintained with azathioprine in a majority of patients.