[Inflammatory bowel diseases]

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Context:

• Inflammatory bowel disease (IBD) management involves various therapeutic agents.
• Surgical interventions are common in IBD treatment.
• Understanding drug-induced complications and treatment efficacy is crucial.

Purpose:

• To review the safety and efficacy of different therapeutic agents in inflammatory bowel disease.
• To assess the impact of pre-operative treatments on surgical outcomes.
• To highlight emerging therapies for ulcerative colitis.

Summary:

• COX-2 specific anti-inflammatory agents may exacerbate inflammatory bowel disease flares, similar to traditional agents.
• Pre-operative administration of steroids, immunomodulators, or infliximab does not elevate post-operative complication risks.
• Hepatitis B reactivation is a risk with infliximab, necessitating pre-treatment screening.
• Adalimumab, a TNF-alpha inhibitor, shows efficacy in patients unresponsive or intolerant to infliximab.
• Leucoapheresis presents a promising therapeutic option for ulcerative colitis.

Impact:

• Informs clinical practice regarding the appropriate use of anti-inflammatory and immunomodulatory drugs in IBD patients undergoing surgery.
• Emphasizes the importance of viral screening prior to biologic therapy to prevent serious infections.
• Highlights the potential of new biologic agents and apheresis techniques in managing refractory IBD.