Immunomodulators: Friends or Enemies in Surgery for Crohn’s Disease?

Landerholm, Kalle; Kalman, Disa; Wallon, Conny; Myrelid, Pär

doi:10.2174/1389450120666190617163919

Cited by 4 publications

(3 citation statements)

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“…However, our own current study and several previous studies from other groups suggest that the above-described factors, delay of surgery, duration of surgery and emergency procedures, are a surrogate for an underlying severe phenotype of CD. The latter might lead to an increase in perioperative morbidity, especially in combination with complex surgical procedures involving the distal colon [ 25 , 27 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and perioperative morbidity and mortality following segmental resections of the colon for Crohn’s colitis

Kappenberger,

Schardey,

Wirth

et al. 2024

Int J Colorectal Dis

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Introduction Crohn’s disease (CD) is a chronic inflammatory bowel disease of a multifactorial pathogenesis. Recently numerous genetic variants linked to an aggressive phenotype were identified, leading to a progress in therapeutic options, resulting in a decreased necessity for surgery. Nevertheless, surgery is often inevitable. The aim of the study was to evaluate possible risk factors for postoperative complications and disease recurrence specifically after colonic resections for CD. Patients and methods A total of 241 patients who underwent colonic and ileocaecal resections for CD at our instiution between 2008 and 2018 were included. All data was extracted from clinical charts. Results Major complications occurred in 23.8% of all patients. Patients after colonic resections showed a significantly higher rate of major postoperative complications compared to patients after ICR (p = < 0.0001). The most common complications after colonic resections were postoperative bleeding (22.2%), the need for revision surgery (27.4%) and ICU (17.2%) or hospital readmission (15%). As risk factors for the latter, we identified time interval between admission and surgery (p = 0.015) and the duration of the surgery (p = 0.001). Isolated distal resections had a higher risk for revision surgery and a secondary stoma (p = 0.019). Within the total study population, previous bowel resections (p = 0.037) were identified as independent risk factors for major perioperative complications. Conclusion The results indicate that both a complex surgical site and a complex surgical procedure lead to a higher perioperative morbidity in colonic resections for Crohn’s colitis.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes and perioperative morbidity and mortality following segmental resections of the colon for Crohn’s colitis

Kappenberger,

Schardey,

Wirth

et al. 2024

Int J Colorectal Dis

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“…Die Immunomodulatorenvor allem Azathioprinund die topischen Steroide erlebten zu Beginn des Jahrtausends ihre höchste Popularität in der CED-Behandlung, was sich auch an den perioperativen Daten gut ablesen lässt. Ihre Bedeutung in der postoperativen Morbidität wird bis heute kontrovers diskutiert [22]. In mehreren eigenen Studien konnten wir jedoch zu keinem Zeitpunkt einen negativen Einfluss des Azathioprins auf die postoperative Morbidität feststellen [16,20].…”

Section: Materials Und Methodenunclassified

Drei Dekaden Darmresektionen bei Patienten mit M. Crohn

2021

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Zusammenfassung Einleitung Die Behandlung des M. Crohn – vor allem die medikamentöse – erlebte in den letzten 20–30 Jahren einen starken Wandel. Die vorliegende Beobachtungsstudie fasst alle Darmresektionen wegen M. Crohn zusammen, die in den letzten 3 Dekaden an 2 großen spezialisierten Zentren durchgeführt wurden. Die perioperativen Trends und Entwicklungen sollten identifiziert werden. Methoden Eingeschlossen wurden alle Darmresektionen bei M. Crohn. Ausschlusskriterien waren: Resektionen bei Malignität, abdominoperineale Rektumexstirpationen wegen Crohn-Analfisteln, ausschließliche Stomaanlagen und -rückverlagerungen und Resektionen, die einen anderen Grund als M. Crohn hatten. Die Daten wurden von 1992 bis 2004 retrospektiv und danach prospektiv gesammelt. Ausgewertet wurden 6 Zeiträume: 1992–1995, 1996–2000, 2001–2005, 2006–2010, 2011–2015 und 2016–2020. Ergebnisse Es wurden 811 Darmresektionen ausgewertet. Zwischen 2000 und 2015 konnten gleich mehrere sehr starke Trends beobachtet werden: erhöhte präoperative Einnahme von Immunmodulatoren und Biologika, sinkende präoperative Steroideinnahme, Verzicht auf präoperative Darmvorbereitung, erhöhter Anteil an voroperierten Patienten und Patienten, die sich mit penetrierendem Befallsmuster vorstellten, Einführung neuer Operationstechniken (Laparoskopie, Stapleranastomosen) und signifikante Erhöhung der postoperativen Morbidität und Stomachirurgie. In den letzten 5 Jahren seit 2016 zeigten sich folgenden Entwicklungen: signifikant weniger Operationen unter Steroideinnahme oder Immunmodulatoren, signifikant mehr Operationen unter Biologika, Wiedereinführung der präoperativer Darmvorbereitung, starke Reduktion der Morbidität und Stomaanlage, höheres Alter der Patienten, weniger aktive Raucher, weniger Operationen wegen penetrierenden Befallsmusters, sehr starker Anstieg laparoskopischer Operationen. Schlussfolgerung Vor allem in den letzten 5 Jahren scheint die Crohn-Chirurgie wesentlich sicherer und weniger invasiv zu werden. Die Daten können jedoch nicht auf größere Populationen übertragen werden.

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“…Although therapeutic efficacy takes several months to be observed, the half-live of these medications is very short. In addition, TPs have not been shown to be associated with postoperative complications in IBD patients [53]. Thus, most surgeons hold TP therapy in the immediate postoperative period and allow the referring gastroenterologist to reassess the need for ongoing IMM therapy.…”

Section: Side Effects and Perioperative Managementmentioning

confidence: 99%

Medical Therapy for Crohn’s Disease

Smith

Holubar

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Antibiotics, probiotics, diets, and fecal transplant do not appear offer clinically significant benefit for treatment of Crohn's disease.• Exclusive enteral nutrition is beneficial in children but has not yet be shown to be of benefit in adults.• 5-Aminosalicylates are widely recognized to have role in treatement of mucosal ulcerative colitis, but have a very limited role in the treatment of CD. • Budesonide is efficacious for induction of clinical remission for CD patients when compared with placebo. • Systemic steroids are indicated for induction of remission, but not for maintenance of remission due to its side effects; steroid dependency is an indication for surgery. • Thiopurine and methotrexate monotherapy is not efficacious for induction of remission, but for maintenance of remission as a steroid-sparing agent; these medications are most commonly used in combination with biologics to decrease immunogenicity to the biologic agent. • Biologic agents are indicated for induction and maintenance of remission in patients with moderate-to-severe Crohn's disease. • Biosimilars present no differences in efficacy or safety compared to their originator compounds and have the advantage of lower cost. • Therapeutic drug monitoring (TDM) of drug levels and anti-drug antibodies (ADA) allows more precise management of patients with Crohn's disease. HistoryThe first case series describing regional enteritis was published in 1932 by a group of physicians at Mount Sinai Medical Center in New York City [1-3]. A senior surgeon, Dr. A.A. Berg, operated on 12 patients with terminal ileitis, and Drs. Leon Ginzburg and Gordon Oppenheimer wrote the initial manuscript. Of note, after Dr. Berg declined to be involved as a coauthor, Dr. Burrill Crohn was brought in as a third contributing author with two additional patients. At that time, the journal's publication policy was to order the authors alphabetically -thus Dr. Crohn was the first author, and regional enteritis subsequently became known as Crohn's disease, not Berg's disease, nor Ginzburg-Oppenheimer disease [3,4].

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Immunomodulators: Friends or Enemies in Surgery for Crohn’s Disease?

Cited by 4 publications

References 189 publications

Clinical outcomes and perioperative morbidity and mortality following segmental resections of the colon for Crohn’s colitis

Clinical outcomes and perioperative morbidity and mortality following segmental resections of the colon for Crohn’s colitis

Drei Dekaden Darmresektionen bei Patienten mit M. Crohn

Medical Therapy for Crohn’s Disease

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