Current trends and challenges in the postoperative medical management of Crohn's disease: A systematic review
Department of Surgery; School of Medicine; Senior Scholars Program
Digestive System Diseases | Gastroenterology | Health Services Administration | Medical Education | Surgery | Surgical Procedures, Operative
BACKGROUND: Crohn's disease is an aggressive chronic inflammatory disorder, and despite medical advances no cure exists. There is a great risk of requiring an operative intervention, with evidence of recurrence developing in up to 80-90% of cases. Therefore, we sought to systematically review the current status in the postoperative medical management of Crohn's disease.
DATA SOURCES: A systematic literature review of medications administered following respective therapy for Crohn's disease was performed from 1979 through 2016. Twenty-six prospective articles provided directed guidelines for recommendations and these were graded based on the level of evidence.
CONCLUSIONS: The postoperative management of Crohn's disease faces multiple challenges. Current indicated medications in this setting include: antibiotics, aminosalicylates, immunomodulators, and biologics. Each drug has inherent risks and benefits, and the optimal regimen is still unknown. Initiating therapy in a prophylactic fashion compared to endoscopic findings, or escalating therapy versus treating with the most potent drug first is debated. Although a definitive consensus on postoperative treatment is necessary, aggressive and early endoluminal surveillance is paramount in the treatment of these complicated patients.
DOI of Published Version
Am J Surg. 2017 Nov;214(5):931-937. doi: 10.1016/j.amjsurg.2017.04.016. Epub 2017 Jun 6. Link to article on publisher's site
American journal of surgery
Schlussel, Andrew T.; Cherng, Nicole B.; and Alavi, Karim, "Current trends and challenges in the postoperative medical management of Crohn's disease: A systematic review" (2017). University of Massachusetts Medical School. Senior Scholars Program. Paper 270.