Use of biologics in crohn’s disease and ulcerative colitis prior to surgery and perioperative risks

Abstract

Medical therapy plays a critical role for induction and maintenance of luminal inflammatory bowel disease (IBD) and fistulizing Crohn’s disease. An exaggerated immune response is thought to contribute to disease; thus, agents referred to as “biologic therapy” have been developed to diminish this immune activity (Bafford et al., J Clin Gastroenterol 47:491-5, 2013). Biologic agents attempt at altering the natural course of IBD by aiding in steroid withdrawal while preserving disease remission (Indar et al., World J Surg 33:1049-52, 2009). Unfortunately biologists have not been able to erase the need for bowel resection thus often proceeding need for surgery (Narula et al., AlimentPharmacol Ther 37:1057-64, 2013; Schluender et al., Dis Colon Rectum 50:1747-53, 2007). This chapter aims to review perioperative risks with use of biologic therapy prior to surgery in IBD.