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 AT, Cherng NB, Alavi K. (2017). Current trends and challenges in the postoperative medical management of Crohn's disease: A systematic review. Senior Scholars Program. https://doi.org/10.1016/j.amjsurg.2017.04.016. Retrieved from https://escholarship.umassmed.edu/ssp/270