• Crohn's disease
• ileal resection

The majority of patients suffering from Crohn's disease will undergo at least one surgical resection of the bowel in the course of their disease. Surgery greatly improves the quality of life in these patients but the beneficial effect is only temporary.

After ileal or ileocolonic resection there is a 20–30% symptomatic recurrence rate in the first year after surgery, with a 10% increase in each subsequent year. Most patients will eventually suffer recurrence, and a reoperation rate of 50–60% is generally reported. The need for simple and effective prophylactic therapy after bowel resection for Crohn's disease is great.

The natural evolution of postoperative Crohn's recurrence has been well studied. After curative resection of the inflamed bowel (that is, removal of all macroscopically involved gut) the disease recurs within weeks to months proximal to the ileocolonic anastomosis.¹ The tissue events can readily be visualised by ileocolonoscopy with biopsy in the months after surgery.

The presence of extensive lesions in the bowel, as visualised at endoscopy in the months after surgery, predicts rapid evolution …