Biologics in peri-operative management of Crohn's disease

The role of biologics for peri-operative Crohn's disease will remain speculative until the accumulation of clinical trial data. The potential positioning of peri-operative biologic therapies includes the prevention of surgery, minimizing surgical morbidity or prevention or delaying post-operative disease recurrence. To date, there is limited, indirect data regarding the potential for infliximab to prevent surgery via the effective treatment of refractory disease and the improvement in fistulizing disease. Although there is no controlled data regarding the impact of biologics on surgical morbidity, patients with stricturing disease have undergone resection without added morbidity. Post-operative trials are certainly needed to ascertain the impact on the inevitability of disease recurrence.