IBD Surgery in the Biologic Therapy Era

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´╗┐IBD Surgery in the Biologic Therapy Era

Abstract and Introduction

Abstract


Purpose of review The relationship between surgery and biologic agents in the management of patients with inflammatory bowel disease continues to be a source of interest for both surgeons and clinicians.
Recent findings The role of biologic agents in patients with varying presentations of Crohn's disease or ulcerative colitis continues to evolve. However, the currently available biologic therapies are clearly not the panacea we have desired because they have only marginally decreased the frequency with which operative intervention is required and may have increased the risk for infectious postoperative complications in the nonelective setting. Compared to surgery, biologic agents are also significantly more costly and may not provide any greater gain in quality of life.
Summary Future studies must focus on the use of surgery and emerging biologic agents as complementary therapies designed to safely control inflammatory disease while providing objective value.

Introduction


We have witnessed a change over recent years in both the operative approach and medical management of inflammatory bowel disease (IBD) with the adoption of minimally invasive surgical procedures and the introduction of biologic agents, respectively. Infliximab, an antitumor necrosis factor (anti-TNF) chimeric antibody, was the first biologic agent approved by the US Food and Drug Administration (FDA) in August 1998 for the treatment of selected patients with Crohn's disease followed by its approval for usage in ulcerative colitis 7 years later. Subsequently, adalimumab and certolizumab pegol were accepted by the US FDA for the management of some patients with Crohn's disease, but these medications have not yet been approved for the treatment of ulcerative colitis. Several centers have recently described their experience related to the impact of biologic agents on the need for surgery, operative morbidity, cost of care, and quality of life.

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