Inflammatory Bowel Disease: Perioperative Pharmacological Considerations

Kumar, Ajay; Aurón, Moisés; Aneja, Ashish; Mohr, Franziska; Jain, Alok; Shen, Bo

doi:10.4065/mcp.2011.0074

Cited by 44 publications

(28 citation statements)

References 97 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…46 Depending on the dose and duration of treatment, stress dosing should be considered during labor and delivery, especially a cesarean delivery, in women exposed to corticosteroids during pregnancy. 47 …”

Section: Corticosteroidsmentioning

confidence: 97%

Care of the Pregnant Patient With Inflammatory Bowel Disease

Matro

2015

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

Inflammatory bowel disease affects women in their peak reproductive years. Patients and physicians often have questions regarding the effect of inflammatory bowel disease on a woman's ability to conceive and to carry a pregnancy safely to term as well as the effect of inflammatory bowel disease and the medications used to treat it on pregnancy outcomes. Women with inflammatory bowel disease have the same rates of fertility as women without inflammatory bowel disease unless they have had prior surgery in the pelvis or active disease. However, women with inflammatory bowel disease do have higher rates of adverse pregnancy outcomes. A multidisciplinary approach involving gastroenterologists, obstetricians, and maternal-fetal medicine physicians should focus on preconception planning and disease optimization before pregnancy. Women with inflammatory bowel disease should be followed as high-risk obstetric patients. Most medications used to treat inflammatory bowel disease can be continued safely during pregnancy and lactation. The greatest risk to the pregnancy is active disease, which can be precipitated by discontinuation of effective maintenance medications. Preconception counseling should include education regarding the low risk of most inflammatory bowel disease medications during pregnancy and lactation and the high risk of a significant disease flare during pregnancy. This review outlines important considerations for obstetricians caring for women with inflammatory bowel disease before and during pregnancy and in the postpartum period.

show abstract

Section: Corticosteroidsmentioning

confidence: 97%

Care of the Pregnant Patient With Inflammatory Bowel Disease

Matro

2015

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…There was no increase in post-operative infection rates for adults with IBD undergoing bowel procedures while on glucocorticoids when compared to adults on purine analogues [18]. Thus, continued use of mercaptopurine likely does not negatively impact post-operative complication rates for adults with IBD.…”

Section: Mercaptopurinementioning

confidence: 82%

“…Kumar et al [18] literature analysis consisting of 84 articles regarding perioperative management of patients with IBD concluded that continued use of mercaptopurine does not negatively influence surgical outcomes or increase morbidity following elective surgery. There was no increase in post-operative infection rates for adults with IBD undergoing bowel procedures while on glucocorticoids when compared to adults on purine analogues [18].…”

Section: Mercaptopurinementioning

confidence: 99%

“…However, the use of cyclosporine is still considered appropriate with special care postoperatively, which includes observations of deterioration in renal function and opportunistic infections [18].…”

Section: Cyclosporinementioning

confidence: 99%

“…Kumar et al [18] suggested that mercaptopurine can be readministered within the first 3 days following surgery contingent upon normal renal functions [18].…”

Section: Mercaptopurinementioning

confidence: 99%

See 2 more Smart Citations

The Safety of Elective Surgery with Concurrent Use of Immunosuppressants

Koons¹,

Plotas²,

Tichansky³

et al. 2017

Glob Surg

View full text Add to dashboard Cite

While providing superior benefits for a cadre of diverse diseases, the prevalence of Immunosuppressive use often brings to question possible additional risks caused by these therapies in the setting of surgical procedures. Specifically, is the risk of impaired wound healing or increased chance of infection worth avoiding the possible side effects associated with temporary cessation during the perioperative period. The appropriate use of immunosuppressants (IS) during elective surgery has been debated extensively with conflicting results, through the current body of literature. Herein, we aim to provide a comprehensive, yet streamlined, overview of the common IS medications that surgeons are likely to encounter in practice in a wide variety of patients. This discussion includes an overview of the pharmacology and use of eight of the common IS medications: azathioprine, cyclosporine, hydroxychloroquine, infliximab, leflunomide, methotrexate, methylprednisolone, and mercaptopurine.

show abstract