Impact of Modern Drug Therapy on Surgery: Crohn's Disease

Kienle, Peter

doi:10.1159/000495127

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…CD is a sort of localized or regional enteritis of unknown etiology associated with pathogenetic factors including impaired immunity, environmental stress, familial inheritance, and certain gene mutations ( Harb, 2015 ; Torres et al, 2017 ; Kienle, 2018 ). CD often onsets in the region of perineal blind and spreads to the whole length of the colon and distal ileum in combination of some extraintestinal complications ( Kienle, 2018 ). Compared with UC, CD tends to be more strongly affected by genetic factors.…”

Section: Part I: Autophagy In Ibdmentioning

confidence: 99%

The Role of Autophagy in Inflammatory Bowel Disease

et al. 2021

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Inflammatory bowel disease (IBD) is an idiopathic intestinal inflammatory disease, including ulcerative colitis (UC) and Crohn’s disease (CD). The abnormality of inflammatory and immune responses in the intestine contributes to the pathogenesis and progression of IBD. Autophagy is a vital catabolic process in cells. Recent studies report that autophagy is highly involved in various kinds of diseases, especially inflammation-related diseases, such as IBD. In this review, the biological characteristics of autophagy and its role in IBD will be described and discussed based on recent literature. In addition, several therapies for IBD through modulating the inflammasome and intestinal microbiota taking advantage of autophagy regulation will be introduced. We aim to bring new insight in the exploration of mechanisms for IBD and development of novel therapeutic strategies against IBD.

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Section: Part I: Autophagy In Ibdmentioning

confidence: 99%

The Role of Autophagy in Inflammatory Bowel Disease

et al. 2021

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“…Pre‐operative immunomodulator use was associated with increased rates of wound infection. Data are conflicting and a Cochrane review is currently underway 37,38 . Surprisingly, perianal disease was correlated with a reduced risk of complications which may reflect the benefits of more frequent biologic use in this cohort (63% [46/73] of cases with perianal disease were prescribed biological therapy versus 49.6% [90/227] of cases without perianal disease p = 0.003).…”

Section: Discussionmentioning

confidence: 85%

A retrospective cohort study: pre‐operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD centre

Meade

Patel

Luber

et al. 2022

Aliment Pharmacol Ther

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Summary Background Low‐quality evidence suggests that pre‐operative exclusive enteral nutrition (E/EN) can improve postoperative outcomes in patients with Crohn's disease (CD). It is not standard practice in most centres. Aims To test the hypothesis that pre‐operative EN in patients undergoing ileal/ileocolonic surgery for CD is associated with improved postoperative outcome. Methods We performed a single centre retrospective observational study comparing surgical outcomes in patients receiving pre‐operative EN (≥600 kcal/day for ≥2 weeks) with those who received no nutritional optimisation. Consecutive adult patients undergoing ileal/ileocolonic resection from 2008 to 2020 were included. The primary outcome was postoperative complications <30 days. Secondary outcomes included EN tolerance, specific surgical complications, unplanned stoma formation, length of stay, length of bowel resected, readmission and biochemical/anthropometric changes. Results 300 surgeries were included comprising 96 without nutritional optimisation and 204 optimised cases: oral EN n = 173, additional PN n = 31 (4 of whom had received nasogastric/nasojejunal EN). 142/204 (69.6%) tolerated EN. 125/204 (61.3%) initiated EN in clinic. Patients in the optimised cohort were younger at operation and diagnosis, with an increased frequency of penetrating disease and exposure to antibiotics or biologics, and were more likely to undergo laparoscopic surgery. The optimised cohort had favourable outcomes on multivariate analysis: all complications [OR 0.29; 0.15–0.57, p < 0.001], surgical complications [OR 0.41; 95% CI 0.20–0.87, p = 0.02], non‐surgical complications [OR 0.24 95% CI 0.11–0.52, p < 0.001], infective complications [OR 0.32; 95% CI 0.16–0.66, p = 0.001]. Conclusions Oral EN was reasonably well tolerated and associated with a reduction in 30‐day postoperative complications. Randomised controlled trials are required to confirm these findings.

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“…Operative complications are increased in patients with a poor nutritional status, perioperative steroid use, and open surgery [91]. Malnourished patients should receive perioperative nutritional support, either enteral or parenteral, and steroids should be tapered before elective surgery [103]. Laparoscopic approaches show similar success rates compared to open surgery, but are associated with shorter recovery and hospitalization periods, reduced rates of bowel obstruction, and better cosmesis [104].…”

Section: • Surgical Therapymentioning

confidence: 99%

Unmet Challenges in Patients with Crohn’s Disease

Scheurlen,

Parks,

Macleod

et al. 2023

JCM

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Patients with Crohn’s disease can present with a variety of clinical manifestations; treatment strategies should focus on long-term remission and improvement of quality of life. There is no standardized process of diagnosing, predicting prognosis, and treating the disease. This narrative review was based on a literature search using PubMed, Embase, and Science Direct. Data on unmet challenges in patients with Crohn’s disease were extracted from identified manuscripts. The aim was to discuss present research on standardized processes in the management of patients with Crohn’s disease and to identify the unmet needs in clinical evaluation and treatment approaches. There is no consensus on standardized diagnostic, treatment, and surveillance algorithms, particularly in assessing complications of Crohn’s, such as stricturing disease, intestinal cancer risk, and cutaneous manifestations. Complications and treatment failure rates of conventional, interventional, and surgical therapy place emphasis on the need for standardized treatment algorithms, particularly in the case of acute complications of the disease. Research on standardized clinical approaches, reliable biomarkers for disease diagnosis and therapy monitoring, and new treatment agents is necessary to improve therapy and reduce complications in patients with Crohn’s disease.

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Impact of Modern Drug Therapy on Surgery: Crohn's Disease

Cited by 9 publications

References 18 publications

The Role of Autophagy in Inflammatory Bowel Disease

The Role of Autophagy in Inflammatory Bowel Disease

A retrospective cohort study: pre‐operative oral enteral nutritional optimisation for Crohnʼs disease in a UK tertiary IBD centre

Unmet Challenges in Patients with Crohn’s Disease

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