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Clin Gastroenterol Hepatol. 2019 Oct 4. pii: S1542-3565(19)31091-2. doi: 10.1016/j.cgh.2019.09.040. [Epub ahead of print]

Peri-operative and Post-operative Management of Patients with Crohn's Disease and Ulcerative Colitis.

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Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address:
Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Gastroenterology, Hepatology, and Nutrition, The Pier C. and Renee A. Borra Family Endowed Chair in Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland, Ohio; Digestive Disease and Surgery Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.


Although the number of available therapies for the treatment of ulcerative colitis (UC) and Crohn's disease (CD) continues to expand, a significant portion of patients with inflammatory bowel disease (IBD) will require surgical intervention. Surgery remains an integral part of the treatment algorithm for patients with UC and CD, and thus multidisciplinary approaches to the perioperative and postoperative management of patients with IBD are critical to improving outcomes during these periods. New mechanisms of biologic therapies are emerging and new treatment strategies focused on earlier and potentially more aggressive use of immunosuppressive therapies are advocated in the current treatment era. In this review, we outline multidisciplinary strategies for the preoperative management of immunosuppressive therapies, including a discussion of the most recent evidence regarding the safety of biologic therapy in the preoperative period. We also discuss the postoperative medical management of patients undergoing intestinal resection for CD, with a particular focus on risk stratification and appropriate therapy selection in the immediate postoperative setting. Finally, we review potential postoperative complications following restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) and their management.


biologics; ileal pouch-anal anastomosis; perioperative therapy; postoperative Crohn’s disease; pouchitis


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