Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients

Aberra, Faten; Lewis, James D.; Hass, David J.; Rombeau, John L.; Osborne, Benjamin; Lichtenstein, Gary R.

doi:10.1016/s0016-5085(03)00883-7

Cited by 315 publications

(187 citation statements)

References 23 publications

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“…During intervals of triple immunosuppression with steroids, CSA, and a thiopurine, many experts treat patients with prophylaxis against Pneumocystis jiroveci ( carinii ), such as trimethoprim / sulfamethoxazole or dapsone. Most authors have found that CSA does not increase the rate of postoperative complications in patients undergoing proctocolectomy ( 281,283 ), in contrast to the preoperative use of corticosteroids in patients with IBD that substantially increases the risk of postoperative infections ( 284 ).…”

Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,141

977

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Guidelines for clinical practice are aimed to indicate preferred approaches to medical problems as established by scientifi cally valid research. Double-blind placebo controlled studies are preferable, but compassionate-use reports and expert review articles are used in a thorough review of the literature conducted through Medline with the National Library of Medicine. When only data that will not withstand objective scrutiny are available, a recommendation is identifi ed as a consensus of experts. Guidelines are applicable to all physicians who address the subject regardless of specialty training or interests and are aimed to indicate the preferable but not necessarily the only acceptable approach to a specifi c problem. Guidelines are intended to be fl exible and must be distinguished from standards of care, which are infl exible and rarely violated. Given the wide range of specifi cs in any healthcare problem, the physician must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the board of trustees. Each has been intensely reviewed and revised by the Committee, other experts in the fi eld, physicians who will use them, and specialists in the science of decision analysis. The recommendations of each guideline are therefore considered valid at the time of composition based on the data available. New developments in medical research and practice pertinent to each guideline will be reviewed at a time established and indicated at publication to assure continued validity. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), grade B indicates that the evidence would be level 2 or 3, which are cohort studies or case -control studies. Grade C recommendations are based on level 4 studies, meaning case series or poor-quality cohort studies, and grade D recommendations are based on level 5 evidence, meaning expert opinion.

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Section: The Patient With Severe Colitis Refractory To Maximal Oral Tmentioning

confidence: 99%

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Kornbluth

Sachar

2010

American Journal of Gastroenterology

1,141

977

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“…17 In a retrospective study, thiopurines alone and the addition of thiopurines for patients under steroids were not found to increase significantly the risk of post-operative infectious complications. 18 Another important point of our pre-operative management was to improve nutritional status when altered. Poor nutritional state and low serum albumin certainly increase post-operative morbidity and the risk of a twostage procedure.…”

Section: Discussionmentioning

confidence: 99%

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

Zerbib

Koriche

Truant

et al. 2010

Aliment Pharmacol Ther

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“…e perioperative use of azathioprine or 6-mercaptopurine, and / or in iximab has not been demonstrated to be a risk factor for postoperative infectious complications, in contrast to corticosteroids that do increase the risk of postoperative infectious complications (262,263) . At present, there is no surgical technique that reduces the risk of postoperative recurrence of CD.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

Self Cite

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients

Cited by 315 publications

References 23 publications

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Ulcerative Colitis Practice Guidelines in Adults: American College of Gastroenterology, Practice Parameters Committee

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

Management of Crohn's Disease in Adults

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