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Biologics and surgical outcomes in Crohn’s disease: is there a direct relationship?
Despite significant advances in medical therapy in the management of Crohn’s disease (CD), surgery is still required in a significant proportion of patients and constitutes an important tool in treatment algorithms. Recently, more options of biological agents have been made available, and most patie...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366403/ https://www.ncbi.nlm.nih.gov/pubmed/32728389 http://dx.doi.org/10.1177/1756284820931738 |
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author | Quaresma, Abel Botelho Yamamoto, Takayuki Kotze, Paulo Gustavo |
author_facet | Quaresma, Abel Botelho Yamamoto, Takayuki Kotze, Paulo Gustavo |
author_sort | Quaresma, Abel Botelho |
collection | PubMed |
description | Despite significant advances in medical therapy in the management of Crohn’s disease (CD), surgery is still required in a significant proportion of patients and constitutes an important tool in treatment algorithms. Recently, more options of biological agents have been made available, and most patients with CD undergoing surgical procedures have been previously exposed to this class of drugs. There is controversy in the literature as to whether anti-tumor necrosis factor (TNF) agents, anti-integrins, or anti-interleukins (ILs) have a direct relationship with increased postoperative complications. In this narrative review, the authors summarize the most important data regarding the effect of biologics on postoperative outcomes in CD. Most studies (with different designs) are based on the experience with anti-TNF agents, mostly with infliximab. Some studies outlined the relationship between vedolizumab and postoperative complications, and there is a lack of data with ustekinumab in this scenario. Most studies are retrospective, but few prospective data are available. A cause–effect (proof of concept) direct relationship between biologics and an increase in postoperative morbidity has not been demonstrated to date. Several confounding factors such as previous use of steroids, malnutrition, and unfavorable abdominal conditions have a definitely effect on postoperative complications in CD. Biologics seem safe to be used in the perioperative period, but available data are still controversial. Multidisciplinary individualized decisions should be made on a case-to-case basis, adapting the surgical strategy according to risk factors involved. |
format | Online Article Text |
id | pubmed-7366403 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-73664032020-07-28 Biologics and surgical outcomes in Crohn’s disease: is there a direct relationship? Quaresma, Abel Botelho Yamamoto, Takayuki Kotze, Paulo Gustavo Therap Adv Gastroenterol Review Despite significant advances in medical therapy in the management of Crohn’s disease (CD), surgery is still required in a significant proportion of patients and constitutes an important tool in treatment algorithms. Recently, more options of biological agents have been made available, and most patients with CD undergoing surgical procedures have been previously exposed to this class of drugs. There is controversy in the literature as to whether anti-tumor necrosis factor (TNF) agents, anti-integrins, or anti-interleukins (ILs) have a direct relationship with increased postoperative complications. In this narrative review, the authors summarize the most important data regarding the effect of biologics on postoperative outcomes in CD. Most studies (with different designs) are based on the experience with anti-TNF agents, mostly with infliximab. Some studies outlined the relationship between vedolizumab and postoperative complications, and there is a lack of data with ustekinumab in this scenario. Most studies are retrospective, but few prospective data are available. A cause–effect (proof of concept) direct relationship between biologics and an increase in postoperative morbidity has not been demonstrated to date. Several confounding factors such as previous use of steroids, malnutrition, and unfavorable abdominal conditions have a definitely effect on postoperative complications in CD. Biologics seem safe to be used in the perioperative period, but available data are still controversial. Multidisciplinary individualized decisions should be made on a case-to-case basis, adapting the surgical strategy according to risk factors involved. SAGE Publications 2020-07-16 /pmc/articles/PMC7366403/ /pubmed/32728389 http://dx.doi.org/10.1177/1756284820931738 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Quaresma, Abel Botelho Yamamoto, Takayuki Kotze, Paulo Gustavo Biologics and surgical outcomes in Crohn’s disease: is there a direct relationship? |
title | Biologics and surgical outcomes in Crohn’s disease: is there a direct
relationship? |
title_full | Biologics and surgical outcomes in Crohn’s disease: is there a direct
relationship? |
title_fullStr | Biologics and surgical outcomes in Crohn’s disease: is there a direct
relationship? |
title_full_unstemmed | Biologics and surgical outcomes in Crohn’s disease: is there a direct
relationship? |
title_short | Biologics and surgical outcomes in Crohn’s disease: is there a direct
relationship? |
title_sort | biologics and surgical outcomes in crohn’s disease: is there a direct
relationship? |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366403/ https://www.ncbi.nlm.nih.gov/pubmed/32728389 http://dx.doi.org/10.1177/1756284820931738 |
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