Does Surgery Help Crohn's Disease?

Relapses After Surgery For Crohn's Disease Are Common

Quitting Smoking
Smoking is associated with Crohn's disease flare-ups, and quitting is the best course of action. Image © Daniel Grill / Getty Images

Talk to just about anyone with Crohn's disease and it's likely that they have had surgery. Approximately half of Crohn's disease patients will have surgery in the first 10 years after diagnosis. Resections to remove diseased tissue are common, and may be repeated as the disease recurs in different sections of the intestine. Crohn's disease can cause narrowing of the bowel, also called a stricture, which may need a type of surgery called strictureplasty.

Complications from Crohn's disease such as abscesses or fissures could also require treatment with surgery.

How Often Crohn's Comes Back After Surgery

Unfortunately, several studies show that symptoms of Crohn's disease, or evidence of disease that can be seen during an examination, often return after surgery. When the disease returns depends on several factors.

Some studies show factors associated with a return of symptoms include peri-anal fistulas, disease located only in the small bowel, previous surgery, a significant amount of affected intestine, and smoking. In fact, smoking seems to be the biggest risk factor. The length of time a person has had Crohn's disease doesn't seem to be a factor in the risk of relapse after surgery. Gender and family history also don't seem to have any affect on the course of Crohn's disease after surgery.

A few studies found that younger age at diagnosis and at the time of the first surgery may also be associated with Crohn's disease relapses after surgery.

Older patients, especially those over the age of 50, may have a lowered risk of relapse. Other studies show no relationship between age and a risk of relapse, so it still remains unclear if age is truly a factor.

Slowing The Rate Of Relapse

There is hope on the horizon to break the cycle of surgery and relapse.

New research is aimed at slowing this rate of relapse after surgery. Some studies show that certain drugs that are commonly used to treat IBD, such as mesalamine (Lialda, Apriso, Pentasa, Canasa, Asacol), azathioprine (Imuran, Azasan), and some antibiotics may help prevent the return of disease after resection surgery. Biologic drugs such as Remicade and Humira have also been studied for use after surgery, and could also be effective, especially after resection in certain areas of the small intestine.

Monitoring For Relapse

An important part of working towards preventing relapses is monitoring for evidence of Crohn's disease after surgery. Using non-invasive methods, such as capsule endoscopy or ultrasounds with contrast, is often preferred. Because smoking is so strongly associated with the return of symptoms, an important step that patients can take to prevent Crohn's from coming back after surgery is to stop smoking.


Bernell O, et al. "Risk factors for surgery and postoperative recurrence in Crohn's disease." Ann Surg January 2000;231:38-45.

Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L. "Review article: the natural history of postoperative Crohn's disease recurrence." Aliment Pharmacol There. 2012 Mar;35:625-33. doi: 10.1111/j.1365-2036.2012.05002.x. 

P Rutgeerts, M Hiele, K Geboes, M Peeters, F Penninckx, R Aerts, and R Kerremans. "Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection." Gastroenterology 108:1617-1621.

Yamamoto T, Watanabe T. "Strategies for the prevention of postoperative recurrence of Crohn's disease." Colorectal Dis. 2013 Dec;15(12):1471-80. doi: 10.1111/codi.12326.

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