The future of surgical management of inflammatory bowel disease

Predictors of recurrence of Crohn’s disease after ileocolectomy: A review

Recurrence after ileocolectomy for Crohn’s disease (CD) is common and occurs in up to 80% of patients. Such recurrence can result in repeated surgical interventions, an increased need for medical treatment and, frequently, an impaired quality of life. The aim of this overview is to provide a summary of the factors associated with disease recurrence after ileocolectomy for CD. Recurrence can be measured clinically or endoscopically using established scoring systems. Radiology and serologic tests can also be used, oftentimes in conjunction with endoscopy and/or clinical findings. Many patient and operative factors as well as pharmacologic treatments have been studied as potential predictors of recurrence. Of these, only smoking and immunomodulatory or biologic medical treatment have repeatedly been shown to effect recurrence. Genetic predictors have been studied and suggested but further evaluation in larger cohorts is necessary. This paper highlights validated, reproducible scoring systems for recurrence and the key findings of studies including patient demographics, operative techniques, various pharmacological treatments and histological findings as predictors of recurrence post ileocolectomy in CD.

A comprehensive review of inflammatory bowel disease focusing on surgical management

The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.

Análise de custo-minimização entre o Infliximabe (IFX) e o Adalimumabe (ADA) no tratamento da doença de Crohn (DC)

INTRODUÇÃO: há uma preocupação crescente com os custos da terapia biológica no tratamento da DC. O objetivo deste estudo foi simular o custo-minimização do tratamento contínuo com o IFX e com o ADA em portadores de DC, num período de 1 ano, em variadas faixas de peso. MÉTODO: estudo farmacoeconômico de custo-minimização na simulação de tratamento com agentes biológicos de pacientes portadores de DC, com pesos diferentes. Os custos foram baseados no preço dos dois medicamentos isoladamente (IFX E ADA). RESULTADOS: o custo do tratamento com IFX (sistema público) foi de R$ 29.411,12 (entre 20 e 40 kg), R$ 44.116,68 (entre 41 e 60 kg), R$ 58.822,24 (entre 61 e 80 kg) e R$ 73.527,80 (entre 81 e 100 kg). O custo com ADA foi de R$ 52.045,16, independentemente do peso. A análise do sistema privado e situações de perda de resposta encontram-se descritas no artigo. CONCLUSÕES: houve menores custos com o uso do IFX abaixo de 60 kg, e com o ADA acima deste peso. Em simulação de perda de resposta ao IFX, houve menores custos absolutos com a troca para ADA do que aumento de dose do IFX, entre 40 e 100 kg.