Management of Crohn’s Disease in Adults

Crohn’s disease (CD) is an idiopathic, incurable chronic inflammatory disease of the GI tract. The characteristic transmural inflammation of CD can occur anywhere along the GI tract, resulting in an inflammatory, fibro-stenotic, or penetrating phenotype. Although the degree of symptoms is variable and may wax and wane throughout the disease course, patients can require chronic immunosuppression and operations to treat the disease symptoms, but both are unable to cure the disease, ⁽¹⁾.

The incidence and prevalence of Crohn’s disease (CD) is on the rise globally, with increases in incidence ranging from 4% to 15% yearly over the past three decades, ⁽²⁾.

Many different medications and combinations thereof are reshaping clinical practice, and refined surgical techniques, tailored approaches, and a wider acceptance of a surgical alternative benefit patients. Hence, the best possible outcomes are currently achieved within dedicated expert centers providing personalized medicine, ^{(3 & 4)}.

Although the rate of surgical intervention for medically refractory disease has decreased over the past 6 decades and less emergent surgery is being performed, a meta-analysis of population-based studies reported that rates of surgical intervention for medically refractory disease remain high at 16%, 33%, and 47% at 1, 3, and 5 years from diagnosis, ^{(5 & 6)}.

After resection, because surgery is not curative, 70% to 90% of patients will have endoscopic recurrence by 1 year and up to 35% of patients will have a repeat intestinal resection within 10 years, ⁽⁷⁾.

Given the typical complexity of patients with CD requiring surgical intervention, multidisciplinary care with gastroenterologists, surgeons, radiologists, pathologists, and other ancillary team members is critical for optimizing patient care, ⁽¹⁾.

Management of CD involves different medical disciplines working in conjunction with one another. These guidelines represent only a portion of the treatment necessary for the optimal care of these patients. This clinical practice guideline will focus on the surgical management of patients with CD.