When people with Crohn’s disease have surgery, the disease often comes back. Researchers looked at 42 studies involving 2,260 patients to find out which medicines work best at preventing this comeback. They found that two injectable medicines called adalimumab and infliximab were the most effective at stopping the disease from returning in the first year after surgery. Another medicine called vedolizumab also helped, but was less powerful. Surprisingly, supplements like vitamin D and probiotics didn’t help prevent recurrence. This research helps doctors choose the best treatment plan for patients after Crohn’s surgery.

The Quick Take

  • What they studied: Which medicines work best at stopping Crohn’s disease from coming back after surgery
  • Who participated: 2,260 adult patients with Crohn’s disease who had surgery, studied across 42 different research trials
  • Key finding: Two biologic medicines (adalimumab and infliximab) were significantly better than other treatments at preventing disease recurrence in the first year after surgery, with adalimumab being most effective at 6 months and infliximab being most effective at 12 months
  • What it means for you: If you need Crohn’s surgery, your doctor may recommend starting one of these two injectable medicines afterward to reduce your chances of the disease returning. However, talk with your doctor about which option is best for your specific situation, as individual responses vary.

The Research Details

Researchers conducted a network meta-analysis, which is a special type of research that combines information from many different studies to compare treatments. They searched medical databases through January 2025 and included 42 studies—mostly randomized controlled trials (the gold standard of research)—that tested different medicines in people who had Crohn’s surgery. They excluded studies on children and studies that only looked at one treatment without comparing it to others.

The researchers tracked two main outcomes: endoscopic recurrence (when doctors see signs of disease returning when they look inside with a camera) at 6 months after surgery, and clinical recurrence (when patients actually feel symptoms returning) at 6, 12, and 18 months. They used statistical methods to rank which medicines performed best at preventing these outcomes.

This approach is powerful because it allows researchers to compare medicines even when they weren’t directly tested against each other in individual studies. It’s like having a tournament bracket where you can determine the best player even if some players never faced each other directly.

This research matters because Crohn’s disease comes back in most patients after surgery—up to 90% experience some signs of recurrence within the first year. Doctors need clear evidence about which medicines work best to prevent this. By comparing all available treatments in one analysis, this study helps doctors make better decisions about what to prescribe after surgery, potentially saving patients from unnecessary disease flare-ups and additional surgeries.

This study is a high-quality systematic review and meta-analysis, which is considered one of the best types of evidence in medicine. The researchers included 38 randomized controlled trials (the most reliable type of study) out of 42 total studies. They looked at a large number of patients (2,260) across multiple studies, which makes the results more reliable. The study was published in a respected medical journal focused on inflammatory bowel diseases. However, the quality of individual studies varied, and some comparisons were based on fewer studies than others, which could affect certainty in some findings.

What the Results Show

At 6 months after surgery, adalimumab (an injectable medicine) was the clear winner at preventing disease recurrence when doctors looked inside with a camera. It was significantly better than thiopurines (older immunosuppressive medicines), probiotics, and vitamin D supplements. Vedolizumab (another injectable medicine) came in second place but wasn’t dramatically different from some other treatments.

At 12 months, infliximab (another injectable medicine) took the top spot, with adalimumab close behind. Both were significantly better than thiopurines, antibiotics, and 5-aminosalicylic acid (an older anti-inflammatory medicine). This pattern continued at 18 months, with these two medicines maintaining their advantage.

When looking at whether patients actually felt symptoms returning (clinical recurrence), the differences between medicines were less clear at 6 months. However, by 12 months, adalimumab and infliximab again showed clear advantages over most other treatments. This suggests these medicines are particularly good at preventing both visible disease signs and actual symptoms.

The research revealed that older treatments like thiopurines and antibiotics ranked lower than the newer biologic medicines at preventing recurrence. Surprisingly, supplements and natural remedies—including curcumin (from turmeric), vitamin D, and probiotics—showed no meaningful benefit in preventing disease from coming back after surgery. This doesn’t mean these supplements are useless for other purposes, but specifically for preventing post-surgery recurrence, they didn’t help in the studies reviewed.

This research builds on previous knowledge by being the first comprehensive comparison of so many different treatments for post-surgery Crohn’s recurrence. Earlier studies had suggested that biologic medicines (which target specific parts of the immune system) were helpful, but this analysis confirms they’re superior to older treatments and ranks them by effectiveness. The finding that supplements don’t prevent post-surgery recurrence is important because it contradicts some popular beliefs about natural treatments for Crohn’s disease.

The study has several important limitations to consider. First, the quality and design of individual studies varied—some were very rigorous while others had weaknesses. Second, some comparisons were based on only a few studies, making those conclusions less certain. Third, the studies measured outcomes in slightly different ways, which required researchers to standardize the data. Fourth, most studies were relatively short-term (6-18 months), so we don’t know if these medicines remain effective long-term. Finally, the studies included mostly adult patients, so results may not apply to children with Crohn’s disease.

The Bottom Line

If you need surgery for Crohn’s disease, discuss with your gastroenterologist (digestive specialist) starting either adalimumab or infliximab after surgery to prevent recurrence. These medicines have strong evidence (high confidence) supporting their use. Vedolizumab is a reasonable alternative if the first two options don’t work for you. Older medicines like thiopurines may be considered if biologics aren’t suitable. Don’t rely on supplements like vitamin D or probiotics alone to prevent recurrence after surgery—they haven’t shown effectiveness for this specific purpose (moderate to high confidence in this finding).

This research is most relevant for adults with Crohn’s disease who are planning surgery or have recently had surgery. It’s also important for gastroenterologists and surgeons who treat Crohn’s patients. If you have Crohn’s disease but haven’t had surgery, this information may still be useful for future planning. People with other types of inflammatory bowel disease (like ulcerative colitis) should not assume these findings apply to them without talking to their doctor.

You should expect to see benefits from these medicines within weeks to months. The research shows they work best when started soon after surgery. Most of the protective effect appears within the first 6 months, though benefits continue and may improve further at 12 months. However, individual responses vary—some people respond quickly while others take longer. Work with your doctor to monitor your response and adjust treatment if needed.

Want to Apply This Research?

  • Track your post-surgery medication adherence (whether you took your medicine as prescribed) and any symptoms weekly, including abdominal pain, diarrhea frequency, and energy levels. Rate each on a scale of 0-10 to monitor trends over the first 12 months after surgery.
  • Set up medication reminders for your injectable medicine (adalimumab or infliximab) on your phone, and log each injection immediately after taking it. This helps ensure you don’t miss doses, which is critical for preventing recurrence. Also track any side effects you experience.
  • Create a monthly summary view showing your symptom trends, medication compliance rate, and any concerning changes. Share this data with your doctor at follow-up appointments (typically at 6 weeks, 3 months, 6 months, and 12 months post-surgery) to help them assess whether your current medicine is working effectively.

This article summarizes research findings but is not medical advice. Crohn’s disease treatment decisions are highly individual and depend on your specific medical history, other health conditions, and previous treatment responses. Do not start, stop, or change any Crohn’s disease medications without consulting your gastroenterologist or healthcare provider. This research applies to adults and may not apply to children. If you’re considering surgery or managing post-surgery treatment, work closely with your medical team to develop a personalized treatment plan based on your individual needs.