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Should biologic agents be stopped before surgery for inflammatory bowel disease?
Karen Zaghiyan1, Dermot McGovern, Phillip Fleshner
1Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Expert Review of Gastroenterology & Hepatology
|November 5, 2014
Summary
For inflammatory bowel disease (IBD) patients needing surgery, anti-TNF biologic agents may increase complication risks, especially in Crohn's disease (CD). Ulcerative colitis patients likely do not need to stop biologics before surgery due to poor absorption.
Area of Science:
- Gastroenterology and immunology
- Surgical outcomes research
Background:
- Anti-tumor necrosis factor (TNF) agents are widely used for inflammatory bowel disease (IBD), yet surgical intervention remains common.
- Patients undergoing surgery often have recent exposure to biologic agents, leading to controversy over surgical outcomes.
Discussion:
- Systemic bioavailability of anti-TNF agents differs between Crohn's disease (CD) and ulcerative colitis (UC), with higher absorption in CD.
- Elevated preoperative serum anti-TNF-α levels in CD patients correlate with increased surgical complication risk.
- Poor systemic bioavailability in most UC patients suggests no need to discontinue biologics before surgery.
Key Insights:
- Preoperative anti-TNF levels may guide surgical timing in Crohn's disease.
- Biologic agent management before colorectal surgery in IBD requires a disease-specific approach.
- Conflicting study results highlight the complexity of biologic effects on surgical outcomes.
Outlook:
- Further research is needed to clarify the precise impact of anti-TNF agents on surgical outcomes in IBD.
- Developing guidelines for perioperative biologic management in IBD patients is crucial.
- Personalized medicine approaches considering drug levels and disease type may optimize surgical outcomes.
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