Miguel Regueiro, MD, on Postoperative Crohn Disease

In this video, Dr Regueiro reviews his presentation at the Interdisciplinary Autoimmune Summit on postoperative Crohn disease, including approaches to follow-up with patients at low or high risk of recurrence of Crohn disease following surgery.

Miguel Regueiro, MD, is professor and chair of the Department of Gastroenterology, Hepatology, and Nutrition at the Cleveland Clinic in Cleveland, Ohio.

TRANSCRIPT

Dr. Miguel Regueiro:  

I'm Dr. Miguel Regueiro. I'm chair and professor in the Department of Gastroenterology, Hepatology, and Nutrition at Cleveland Clinic In Cleveland, Ohio. At the virtual IAS this year, I spoke on postoperative Crohn’s disease.

Some of the take-home messages from my talk were understanding the risk factors for postoperative Crohn’s disease recurrence, meaning, who’s a low risk for having their Crohn’s disease come back after surgery, and who’s at a high risk for Crohn’s disease coming back after surgery. In the patients with low risk, we can probably watch and wait. Meaning patients undergo resection, a primary anastomosis, probably an ileal colonic anastomosis, and we can follow with fecal calprotectin at 3 months, a colonoscopy at 6 to 9 months, and if they’re clean, there’s no active Crohn’s, you don’t necessarily start them on treatment or any medication.

However, the high-risk for recurrence patient—and these are usually patients who have penetrating or fistulizing Crohn’s disease, they’ve had multiple surgeries already, cigarette smokers as well, and obviously we want our smokers to quit smoking—but those risk factors portend a higher risk for recurrence after surgery. Those are the patients I talked about starting and initiating treatment shortly after their surgery, so not waiting for recurrence, but taking more of a preventive approach. The best-studied medicine to date has been infliximab for the prevention of postoperative Crohn’s disease, but I also talked about other treatments such as antibiotics and other monoclonal antibodies, and really where I think the field is evolving in the management of postoperative Crohn’s disease.

So hopefully if you saw the talk you enjoyed it. This is always a hot topic, it’s something we see quite a bit in gastroenterology, and hopefully you found this informative. Thank you very much.