Miguel Regueiro, MD, on Medical-Surgical Conundrums in IBD

Dr Regueiro discusses his presentation at GUILD 2023 on multidisciplinary approaches needed to manage anal strictures, peristomal complications, diversion colitis and proctitis, pouchitis and other complications of inflammatory bowel disease.

Miguel Regueiro, MD, is chair of the Digestive Disease & Surgery Institute at Cleveland Clinic in Cleveland, Ohio. 

TRANSCRIPT:

I’m Dr Miguel Regueiro, the chair of the Digestive Disease and Surgery Institute at Cleveland Clinic in Cleveland, Ohio, and this year at GUILD 2023, I was given the very interesting topic of medical surgical conundrums in IBD.

Why is this so interesting? Well, many of us who treat inflammatory bowel disease patients know that this is really a multidisciplinary disease, and often gastroenterologists are working very closely with our surgeons to manage these conditions. So some of the topics I covered in my GUILD talk on medical surgical conundrums were how to manage the anal stricture, how to manage the retained rectal stump after surgery, how to treat diversion proctitis or diversion colitis, how to treat the peristomal complications, and then I touched on some of the pouch complications, and also finally, how we manage perioperative medications.

So just some of the highlights: for the anal strictures, we know that if we can dilate the anal stricture and then sometimes have the patients self-dilate, they actually do quite well. But if that doesn't work, unfortunately, sometimes we need to have our patients get surgery, which leaves them with an ostomy.

For a diversion proctitis or colitis, we know short-chain fatty acid enemas work, or just reconstituting the bowel, doing a take-down of ileostomy to the colon.

For the rectal stump, generally we don't need to do much with that. But if the patient does have cancer, sometimes that needs to be removed. And then I talked a lot about peristomal complications from pyoderma to immune-mediated diseases to skin breakdown.

And then I ended with pouch complications, and given the fact that we now have many biologics we now know we can safely continue biologic therapy before surgery. That was a very important take-home point. This came from the PUCCINI study which showed that you can continue anti-TNF and biologics, then go to surgery. You don't need to stop them and be off of them for a period of time.

So that's what I talked about at Guild 2023. As always, it was a phenomenal conference. And hopefully people learn something from that.