Updates in the Management of Crohn's Disease

Sergey Khaitov, MD, FACS, FASCRS

Crohn's disease remains to be a global problem causing significant impact on quality of life of affected patients. It is on the rise, especially in developing countries, and might be related to urbanization and better recognition.

It represents a broad spectrum of clinical presentations and severity and unfortunately remains incurable currently despite enormous progress made in recent years in understanding the immunologic basis of this devastating illness.

In recent decades tens of new medical agents were developed to influence various steps in immune disarray of Crohn's patients. While most of them prove to be effective and the incidence of surgery needed for mild-to-moderate illness has decreased—still, up to 80% of patients will end up with at least one surgery in their lifetime and many more than once!

As mentioned, surgeries will not cure the disease, but they often can provide an effective and fast control of disease symptoms and especially complications. Our surgical enthusiasm will have to be measured against possible surgical complications and sometimes debilitating results of repeated surgeries leading to long-term disabilities like short gut syndrome, permanent ostomies, fecal incontinence. Old principle of medicine stays the same—Primum non nocere!

It became clear that the multifaceted nature of Crohn's disease affects not only the intestinal tract and nearly any system in the body but also patients' minds. Proper management absolutely needs a multidisciplinary approach with gastroenterologists, nutritionists, enterostomal therapists, psychologists. All the specialists should have expertise specifically in management of Crohn's disease—this is best done in settings of specialized Inflammatory Bowel Disease Center. Many centers are organized in major institutions throughout the country.

But access to Crohn's specialized tertiary care may be limited. Our goal is to provide support and knowledge from the busiest surgeons and gastroenterologists in the field of Crohn's disease for a broad group of practitioners who will encounter those patients.

In this issue of Clinics in Colon and Rectal Surgery, we are trying to touch upon most difficult aspects of this illness related to surgical care ranging from intestinal to anorectal management. We also connected with gastroenterology colleagues to have their input specifically on evolving problems of Crohn's like ileal pouch illness.

I am personally blessed to work at the institution where Crohn's history was made at the Mount Sinai Hospital in New York. I hope that with the contribution of our premier authors team we will cover the main difficult issues, which surgeons will encounter in their practice, and this will help improve quality of life and prevent complications in our patients.

Sergey Khaitov, MD, FACS, FASCRS

Publication History

Article published online:
25 April 2024