Two pictures to understand the comprehensive management methods of "Crohn's disease surgery"

Introduction Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that often requires bowel resection.

CD is difficult to manage after surgery because patients are at risk of a more severe course and multiple symptoms.

Symptoms of intestinal inflammation are not very sensitive and specific, and other factors [such as bile acid diarrhea, fat malabsorption, and small intestinal bacterial overgrowth (SIBO)] often cause corresponding symptoms, which need to be monitored and personalized management .

This review aims to provide an overview of postoperative monitoring and management methods for CD patients based on emerging methods and data.

The new non-invasive detection method for postoperative monitoring of CD patients can also exclude other causes of symptoms (serum C4, fecal fat, SIBO breath test), and evaluate intestinal inflammation (fecal calprotectin, endoscopic healing index).

In addition, endoscopes need to be used to evaluate and manage disease activity.

Endoscopy should be performed within 6 months after surgery, and then colonoscopy every 1-2 years can be considered to ensure timely detection of late recurrence.

Patients undergoing multiple resections should be screened for short bowel syndrome (Figure 1).

Figure 1 Postoperative monitoring methods for CD patients* All other causes listed should be detected at the same time, and intestinal inflammation should be detected to avoid delays in treatment.
During clinical follow-up, if timely endoscopic evaluation is not possible, fecal calcium guarding can be performed Protein or endoscopic healing index examination, and can rely on this index alone.

If endoscopy can be used for longitudinal objective assessment of remission, the above-mentioned non-invasive examination + fecal calprotectin, serum endoscopic healing index++ including orthostatic symptoms, excessive thirst and steatorrhea CD patients should still be performed.
Postoperative personalized management methods For patients who have failed preoperative treatment with biological agents, postoperative preventive biological treatment needs to be cautious.

There is currently no high-quality data to guide which agent should be selected.

For patients with sufficient concentration of biological agents but treatment failure, biological agents with alternative mechanisms of action can be selected, and patients with previous drug intolerance can choose different drugs for treatment.

More personalized management methods for CD patients are shown in Figure 2.

Figure 2 Individualized management method after CD + 3 months of metronidazole treatment is reasonable for patients with intolerance #Select biologics based on past drug exposure history and history of intolerance * According to fecal calprotectin, internal Microscopic healing index or endoscope diagnosis literature index: Battat R, Sandborn WJ.
Advances In The Comprehensive Management of Post-Operative Crohn's Disease[J].
Clinical Gastroenterology and Hepatology (2021), doi: https://doi.
org /10.
1016/j.
cgh.
2021.
03.
048.
Contribution email: tougao@medlive.
cn