How to Manage Crohn’s Disease After Ileocolonic Resection?

Abstract

Diarrhea after ilecocolonic resection is common. Besides CD recurrence, bile acid-induced diarrhea (observed in up to 80% of subjects, often transient 22) needs to be considered. Especially with low fecal calprotectin (FC) levels a therapeutic trial of bile acid sequestrants is recommended (cholestyramine, colestipol or colesevelam depending on Most current article

It Is All in the Fine Print: A Call for a Histopathology Checklist for IBD

“…A lthough recurrence after a curative ileocecal resection is the norm rather than the exception in patients with Crohn's disease (CD), there is enough heterogeneity in the timing and severity of recurrence to make management of CD in this setting both nuanced and individualized. 1,2 Two decades ago when medical options were limited and we had yet to fully recognize the importance of early intervention to maximize effectiveness of treatments, management of CD after a curative resection involved either continuation of the same previously ineffective therapy or a "wait-and-watch" approach that monitored for symptomatic recurrence to reinitiate treatment. However, fundamental advances made in the past decade have emphasized the superior efficacy of newer agents (particularly tumor necrosis factor antagonists) in preventing recurrence when initiated soon after surgery 3 as well as the importance of assessment of endoscopic recurrence proactively within 6-12 months after the initial resection to optimize postoperative treatment.…”

“…Such tools include smoking status, disease phenotype, and surgical history. 2,6 Factors such as surgical anastomosis type and length of bowel resected are less well-replicated, often limited by heterogeneity between cohorts or small sample sizes. In this issue of the Journal, Tandon et al 7 present a rigorous metaanalysis examining the role of histologic features in predicting postoperative recurrence in CD.…”