Miguel Regueiro, MD, on Postoperative Crohn's Disease

Dr Regueiro recaps his keynote address on the management postoperative Crohn's disease, including new surgical techniques and medications that could help prevent the occurrence of postoperative disease.

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

TRANSCRIPT:

I'm Miguel Reguero. I'm professor of medicine and chief of the Digestive Disease Institute at Cleveland Clinic in Cleveland, Ohio. And at this year's AIBD 2023, I gave a keynote address on postoperative Crohn's disease. As many of you know, this has been a passion of mine and, actually, a career research goal of mine, to look at how we can prevent postoperative Crohn's disease.

So at AIBD 2023, I talked about how we manage post-op Crohn's, but some of the other factors that included in risk. I reviewed some of the microbiome data that's come out. I reviewed some of the new surgical techniques that actually may prevent post-op Crohn's. But importantly, I reviewed the medications and some of the newer medicines that we're now using to prevent post-op Crohn's. Many of these studies that I had done on TNF inhibitors, I still think many of us use that in the post-op structure. However, with the REPREVIO study, which was just, actually presented recently, this is now looking at vedolizumab. So we have a second biologic agent to prevent postoperative Crohn's in vedolizumab. And I went through some of the positioning of which one I use when and that type of thing.

And then finally, the most important part of the postoperative Crohn's disease paradigm, and I think a shift that we've all seen, and I ended with an algorithm as far as how I approach postoperative Crohn's: low risk for occurrence, high risk for occurrence. Some of the data that Dr Agrawal presented on especially those low-risk patients where maybe surgery, and even in early surgery, patients will do well for years. Doesn't mean they're cured of Crohn's, but maybe we can monitor them.

So one aspect that I ended with is the importance of monitoring postoperative Crohn's disease, meaning getting a fecal calprotectin 3 months after the surgery. If you have availability to intestinal ultrasound, an intestinal ultrasound 3 to 6 months after to look for recurrence, and then doing a colonoscopy depending on that at the 6- to 12-month time point. So that monitoring strategy now allows us to decide if we need to early intervene for recurrence in a patient who's not on therapy, or if they are on therapy and they have evidence of early recurrence, we can optimize therapy or even switch to a different mechanism of action. So hopefully, that was useful. I think the audience is starting to look at postoperative Crohn's in a more aggressive manner in terms of monitoring. Thank you very much.