Jordan Axelrad, MD, on Postoperative Crohn's Disease

Dr Jordan Axelrad reviews the key points of his presentation on postoperative management for patients with Crohn's disease from the AIBD Regional meeting.

Jordan Axelrad, MD, MPH, is an associate professor and director of Clinical and Translational Research at the Inflammatory Bowel Disease Center at NYU Langone Health in New York, New York.

I'm Jordan Axelrad from NYU Langone Health and I'm here at AIBD Regionals where I just presented on postoperative Crohn's disease. Postoperative Crohn's disease is a little bit of an evolving topic. Many patients with Crohn's require surgery and the most common surgery that's required is an ileocecal resection. Typically, this is done for stricturing or refractory small bowel disease. And there's lots of questions about the right therapeutic management after patients require surgery for Crohn's disease.

What we found is that there are certain clinical characteristics that can help us determine whether patients are high- or low-risk for having recurrence of Crohn's disease after surgery. Some of those characteristics include very young age, previous surgery, or even retention of positive margins, for example, with disease activity after surgery.

For these patients, medical prophylaxis is indicated. And that prophylaxis is typically an anti-TNF therapy where we have the best data. However, other biologic agents are also effective, and there's pretty good data for ustekinumab and vedolizumab, as well, in the postoperative Crohn's setting.

What's also important about medical prophylaxis after surgery for Crohn's disease is that this should be initiated early and we shouldn't wait for endoscopic disease recurrence to initiate therapy. In all patients they should be monitored after surgery and typically that's done with an endoscopic assessment around month 6. And for low-risk patients who are not initiated on medical prophylaxis, if there is evidence of recurrence of endoscopic Crohn's, they should then be initiated on medical therapy for that recurrence.

Despite that, obviously there's still a lot of unmet need in this area. And hopefully with future therapeutics that are more effective and better positioned for individual patients, we may be able to avoid surgery. But as we know, despite that, surgery is still incredibly common and can really help patients who have indications for it. And what's important is initiating medical prophylaxis for the right patient to prevent recurrence of disease and then identifying recurrence should it happen and initiating therapy at that time or optimizing or adjusting therapy if required.

Thank you.