Dr Regueiro reviews his address on the management of complex Crohn's disease from the American College of Gastroenterology scientific meeting in Philadelphia.

Miguel Regueiro, MD, is professor of medicine and chair of the Digestive Disease Institute at Cleveland Clinic in Cleveland, Ohio. 

TRANSCRIPT:

I'm Dr. Miguel Regueiro coming to you from ACG 2024. I'm at the Cleveland Clinic and I'm the Chief of the Digestive Disease Institute. At ACG 2024, in the postgraduate course with IBD, I talked about complex Crohn's disease.

Some of the key points that I made here that we need to start early effective therapy, especially in patients with high risk factors, young patients, those that have deep ulcers, those with perianal disease. I reviewed the positioning of the therapies that we use for complex Crohn's disease, and also the safety of these therapies. So for example, using infliximab and azathioprine for fistulizing Crohn's is still a first -line therapy, even though I put that at the bottom of my safety pyramid. However, the interleukin-23s, the JAK inhibitors, are very effective therapies in Crohn's disease, and I talked about how to position those as well.

And then finally, in my complex Crohn's disease talk, I said, let's not forget the colorectal surgeon. Sometimes surgery is the best approach for complex Crohn's. The patient needs an ileocecal resection and anastomosis and then I went into when we start medicines after surgery and when we hold off.

So the bottom line is in low-risk patients, meaning their first surgery after a long period of time, it's absolutely fine now to monitor those patients postop with a fecal calprotectin, ultrasound of their intestine, or colonoscopy within the first year, and if they have no disease, continue to monitor. If they have disease, start therapy. That's unlike the high-risk patient who may be on their second or third surgery or have fistulizing complications. Those are the patients we would start medicine after surgery, and really the 2 trials that have been done are the one that I did, on infliximab after surgery, and then the more recent REPREVIO vedolizumab study. Both showed benefits starting either of these agents after surgery. So thank you very much.