Dr Hyman explains how surgery can be a highly efficacious option for first-line therapy of penetrating Crohn disease.

Neil Hyman, MD, is chief of the Section of Colon and Rectal Surgery at University of Chicago Medicine.

TRANSCRIPT:

Hi, I'm Neil Hyman, chief of colorectal surgery at the University of Chicago. I'm here at the Crohn's and Colitis Foundation Congress. We just completed our so-called Shark Session, which is a new session for this meeting in which basically one of the presenters would make a pitch about a certain strategy or a certain approach to a problem in inflammatory bowel disease, and then they'd get questioned and comments by a shark panel, if you will.

So my topic was that surgery is necessary for perforative complications of Crohn's disease. And like most of the topics that were presented, in many aspects of IBD there really are not absolutes, “always or never,” but indeed I think the argument I tried to make is that surgery is typically required for patients with perforative complications of Crohn's disease. And I think the central point that I wanted to highlight is I'm a surgeon, but in these GI meetings, my talented and skilled gastroenterology colleagues will really do a great job of talking about how they thread the needle with medical therapy for Crohn's disease, meaning how they optimize care and optimize medications to give the patient the highest probability or the highest chance of clinical remission. But the fact of the matter is that clinical remission remains the exception rather than the rule for Crohn's disease.

So with that as a background, the other talent and skill that I think the truly expert gastroenterologists have is they understand when medical therapy is unlikely to be successful and surgery is required. And I think perforative complications, meaning not all circumstances, but most patients who have abscesses, fistulas, are going to end up needing surgery. That being said, what's interesting to me as getting to be rather advanced in my career is that when I was a young doctor and we had very few effective treatments for Crohn's disease, we actually tried to hold off surgery for as long as possible because we would do the surgery, remove the diseased bowel, and some patients would recur a few months later, some a few years later, some never, but you never really knew what was going to happen.

But I think now with all of the reasonably effective therapies and biologics that we have, it's a game changer in that paradoxically it drives us, I think, sometimes to surgery earlier, because we know if we can hit the reset button and remove the diseased, perforated bowel, that this will really give our GI colleagues an opportunity to keep the patient healthy; so that in other words, we'll remove the diseased area, then they'll be monitoring, for example with a colonoscopy 6 months later, to make sure that the patient is on the right medication at the right dose. And I guess my last comment is, that I think to me a central point is that IBD management is a team sport, and we often will characterize, say, surgery versus medicine as competitive, but in fact they're collaborative and should be collaborative.