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Immunomodulators and biologics reduces surgical bowel resection in children with Crohn's

The most recent issue of the Inflammatory Bowel Diseases examines the effect of immunomodulators and biologics on indication for surgical bowel resection in children with Crohn's disease.

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Despite advances in medical therapies, many children with Crohn's disease will require bowel resection.

Although previous registry studies have attempted to identify risk factors for surgery, the effect of immunomodulators and biologics on surgical indications has not been well characterized.

Dr Lori Zimmerman and colleagues reviewed a series of 125 children with Crohn's disease who underwent bowel resection with reanastomosis between 1977 and 2011 and were followed up for at least 6 months.

The researchers compared patients who underwent surgery for perforating disease, and patients who were operated on for medically refractory or fibrostenosing disease.

Between these 2 groups, the team examined medications received before surgery.

Other demographic and disease-specific covariates were examined.
53% of patients required surgery for strictures or refractory disease
Inflammatory Bowel Diseases

Of the 82 patients who received IMB before surgery, only 23% of patients required surgery for a perforating complication of Crohn's disease, whereas 77% of patients required surgery for strictures or medically refractory disease.

The researchers found that of the 43 patients who did not receive immunomodulators and biologics preoperatively, 45% of patients developed a perforating complication, and 53% of patients required surgery for strictures or refractory disease.

These team noted that these differences across groups were significant, with a lower rate of operation for perforating disease among patients receiving preoperative immunomodulators and biologics therapy.

Dr Zimmerman and team comment, "In our surgical cohort, children with Crohn's disease who were treated with immunomodulators and biologics therapy were less likely to have surgery for perforating disease."

"This finding raises the possibility that the administration of immunomodulators and biologics in children who require surgery may be associated with a difference in disease behavior."

Inflamm Bowel Dis 2014: 20(6): 1015-1020
28 May 2014

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