Management of Crohn’s disease: summary of updated NICE guidance

Martins, Rui; Carmona, Chris; George, Bruce; Epstein, Jenny

doi:10.1136/bmj.l5940

Cited by 13 publications

(11 citation statements)

References 2 publications

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“…This trial is randomising patients to one of four groups; It will be a significant breakthrough in the management of CD if the Kono-S anastomosis or extended mesenteric resection are definitely proven to be effective at reducing POR after ileocolic resection, particularly given the lack of certainty regarding the efficacy of medications at reducing POR. The evolution of new techniques are coming at an important time when we are likely to see more patients with isolated ileocolic disease being referred for consideration for surgical resection (106)(107)(108)(109). The reason for this is based on a number of publications including the LIR!C trial which has demonstrated that laparoscopic ileocaecal resection is cost effective and results in similar quality of life as induction and maintenance treatment with infliximab in patients with non-stricturing limited (affected segment ≤40 cm) ileocaecal CD for whom conventional treatment was unsuccessful (110,111).…”

Section: Discussionmentioning

confidence: 99%

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

et al. 2021

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Postoperative recurrence after ileocaecal resection for fibrostenotic terminal ileal Crohn's disease is a significant issue for patients as it can result in symptom recurrence and requirement for further surgery. There are very few modifiable factors, aside from smoking cessation, that can reduce the risk of postoperative recurrence. Until relatively recently, the surgical technique used for resection and anastomosis had little or no impact on postoperative recurrence rates. Novel surgical techniques such as the Kono-S anastomosis and extended mesenteric excision have shown promise as ways to reduce postoperative recurrence rates. This manuscript will review and discuss the evidence regarding a range of surgical techniques and their potential role in reducing disease recurrence. Some of the techniques have been shown to be associated with significant benefits for patients and have already been integrated into the routine clinical practice of some surgeons, while other techniques remain under investigation. Current techniques such as resection of the mesentery close to the intestine and stapled side to side anastomosis are being challenged. It is looking more likely that surgeons will have a major role to play when it comes to reducing recurrence rates for patients undergoing ileocaecal resection for Crohn's disease.

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Section: Discussionmentioning

confidence: 99%

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

et al. 2021

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“…This perspective with differences in clinical practice result in decreased numbers of CD-related surgery, which is demonstrated by data from Canada and Australia [25,26]. In contrast, the British National Institute for Health and Care Excellence (NICE) recommends surgery already at an early stage of the disease as therapeutic alternative [27]. This approach is also supported by German guidelines whereas British and German societies recommend introducing all therapeutic alternatives to patients while taking into account the state of disease as well as individual risks and benefits and personal preferences [27,28].…”

Section: New Evidence Strengthens the Role Of Early Surgical Intervention In Limited CDmentioning

confidence: 99%

“…In contrast, the British National Institute for Health and Care Excellence (NICE) recommends surgery already at an early stage of the disease as therapeutic alternative [27]. This approach is also supported by German guidelines whereas British and German societies recommend introducing all therapeutic alternatives to patients while taking into account the state of disease as well as individual risks and benefits and personal preferences [27,28]. Similarly, updated European Crohn's and Colitis Organization (ECCO) guidelines introduce surgery as a primary treatment option in the case of localized CD as an equal therapeutic alternative to Tumor Necrosis Factor alpha inhibitor infliximab.…”

Section: New Evidence Strengthens the Role Of Early Surgical Intervention In Limited CDmentioning

confidence: 99%

“…British National Institute for Health and Care Excellence (NICE) [27] Surgery is recommended at an early stage of the disease as therapeutic alternative to medical therapy.…”

Section: Society/organization Recommendationmentioning

confidence: 99%

“…Based on the current evidence, all available therapeutic alternatives (medical versus surgical) should be discussed with patients with localized ileocecal CD early, considering the risks and benefits as well as the personal preferences of patients as already recommended by British (NICE) and European (ECCO) guidelines [27,29]. This is an important and relevant development since surgery was indicated only in case of therapeutic refraction or enteric complications in the past.…”

Section: Introductionmentioning

confidence: 99%

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The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

et al. 2021

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Crohn’s disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.

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Fertility issues, fertility preservation, and pregnancy outcome in long‐term survivors

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Loren

Thewis

et al. 2021

Blood and Marrow Transplantation Long Term Management

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Management of Crohn’s disease: summary of updated NICE guidance

Cited by 13 publications

References 2 publications

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

Fertility issues, fertility preservation, and pregnancy outcome in long‐term survivors

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