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Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar

Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar is a topic covered in the ASCRS Webinars.

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Surgical Management of Ulcerative ColitisSurgical Management of Ulcerative Colitis

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Description

There continues to be controversy regarding the surgical treatment of ulcerative colitis, even more so in this era of biologic therapy. Patients failing medical management will still be treated with colectomy, but now will commonly go to the OR with some biologic agent having been given. Data looking at complications and outcomes associated with surgery and biologic use is difficult to interpret due to the preselected nature of this group of patients, their variable degree of wellbeing at the time of surgery, the variable phenotype of the illness itself and a multitude of differing biologics now being used. However, with time and increasing experience an evolving consensus is emerging, especially insofar as patients undergoing the IPAA procedure. Surgeons need to be aware of factors that can improve or worsen surgical complications associated with the IPAA procedure in patients treated with biologics.

Once the patient undergoes definitive IPAA reconstruction, too often the enigmatic complication of pouchitis will occur. Depending on study and duration of follow up, up to 50% of patients will suffer the signs and symptoms of pouchitis within two years of IPAA creation. Pouchitis suggests itself to be (like IBD) the consequence of the combined effects of genetic predisposition and noxious enteric agents but is very much more responsive to medications, especially antibiotics than the original ulcerative colitis. However, there is, like IBD, a spectrum of pouchitis severity that demands a measured approach with differing therapies based on the specifics of presentation. Though antibiotics may work on mild pouchitis, more severe forms require more aggressive therapy including possibly biologic therapy. The surgeon should be aware of the varying forms and causes of pouchitis, to then be able to institute the appropriate therapy.

Moderators: Walter A. Koltun, MD
Speakers: Samuel Eisenstein, MD, Matthew Mutch, MD

Credit Hours Available: 1 AMA PRA Category 1 Credit(s)™
Release Date: November 8, 2018
Reviewed Date: January 2021
CME Expires: November 8, 2023

-- To view the remaining sections of this topic, please log in or purchase a subscription --

Description

There continues to be controversy regarding the surgical treatment of ulcerative colitis, even more so in this era of biologic therapy. Patients failing medical management will still be treated with colectomy, but now will commonly go to the OR with some biologic agent having been given. Data looking at complications and outcomes associated with surgery and biologic use is difficult to interpret due to the preselected nature of this group of patients, their variable degree of wellbeing at the time of surgery, the variable phenotype of the illness itself and a multitude of differing biologics now being used. However, with time and increasing experience an evolving consensus is emerging, especially insofar as patients undergoing the IPAA procedure. Surgeons need to be aware of factors that can improve or worsen surgical complications associated with the IPAA procedure in patients treated with biologics.

Once the patient undergoes definitive IPAA reconstruction, too often the enigmatic complication of pouchitis will occur. Depending on study and duration of follow up, up to 50% of patients will suffer the signs and symptoms of pouchitis within two years of IPAA creation. Pouchitis suggests itself to be (like IBD) the consequence of the combined effects of genetic predisposition and noxious enteric agents but is very much more responsive to medications, especially antibiotics than the original ulcerative colitis. However, there is, like IBD, a spectrum of pouchitis severity that demands a measured approach with differing therapies based on the specifics of presentation. Though antibiotics may work on mild pouchitis, more severe forms require more aggressive therapy including possibly biologic therapy. The surgeon should be aware of the varying forms and causes of pouchitis, to then be able to institute the appropriate therapy.

Moderators: Walter A. Koltun, MD
Speakers: Samuel Eisenstein, MD, Matthew Mutch, MD

Credit Hours Available: 1 AMA PRA Category 1 Credit(s)™
Release Date: November 8, 2018
Reviewed Date: January 2021
CME Expires: November 8, 2023

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: February 25, 2022

Citation

"Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar." ASCRS Webinars, 2022. ASCRS U, www.ascrsu.com/ascrs/view/ASCRS-Webinars/2871022/all/Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar.
Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar. ASCRS Webinars. 2022. https://www.ascrsu.com/ascrs/view/ASCRS-Webinars/2871022/all/Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar. Accessed March 21, 2023.
Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar. (2022). In ASCRS Webinars https://www.ascrsu.com/ascrs/view/ASCRS-Webinars/2871022/all/Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar
Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar [Internet]. In: ASCRS Webinars. ; 2022. [cited 2023 March 21]. Available from: https://www.ascrsu.com/ascrs/view/ASCRS-Webinars/2871022/all/Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar ID - 2871022 Y1 - 2022/02/25/ BT - ASCRS Webinars UR - https://www.ascrsu.com/ascrs/view/ASCRS-Webinars/2871022/all/Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar DB - ASCRS U DP - Unbound Medicine ER -
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    • ASCRS Webinars
    • Anorectal
    • Contemporary Management of Complex Anorectal Fistulae
    • Pilonidal Disease
    • Benign
    • Complex Anorectal Crohn's Disease
    • Management of the Failing Pelvic Pouch
    • Surgical Treatment of IBD in the Era of Biologics: Ileal Pouches and Pouchitis Webinar
    • The Data is in the Details: Data-Driven IBD Case Studies
    • Malignancy
    • Impact of Genetics on Treatment of Colorectal Cancer
    • Management of Metastatic Colon Cancer
    • Management of Rectal Cancer in the 21st Century
    • Surgical and Non-Surgical Approaches to the Management of Rectal Cancer
    • Pelvic Floor
    • Fecal Incontinence
    • Incorporating Imaging Modalities into Clinical Decision Making for Patients with Pelvic Floor Disorders
    • Rectal Prolapse
    • The Many Shades of Obstructed Defecation Syndrome
    • Understanding Low Anterior Resection Syndrome: Definitions, Treatments, and Ways to Improve Quality of Life
    • Perioperative
    • Enhanced Recovery Program Guidelines
    • Geriatric Surgery 101: Peri-operative Considerations for Optimization
    • How to Manage and Prevent Complications
    • My Patient is 90 and Has Colorectal Cancer – How Can I Best Care for a Frail Older Adult?
    • Peri-operative Pain Control Methods in Abdominal and Anorectal Surgery
    • Miscellaneous
    • Coding and Reimbursement Updates for 2021
    • Comprehensive Care of the Patient Living with an Ostomy: A Multidisciplinary Approach
    • Current Challenges in Colorectal Surgery: An International Perspective During the COVID 19 Pandemic
    • Diversity, Equity and Inclusion Best Practices: Now is the Time to Embrace Change
    • Surgeon Burnout: How to Foster Resiliency
    • Surgical Legislative Advocacy and Healthcare Reform
    • The Emergence of Artificial Intelligence in Surgery: Will machine learning lead to the next big disruption in practice and training?
    • Training the Colorectal Surgeons of the Future: The Role of Simulation, Artificial Intelligence, 3D Imaging
    • Updates in Advanced Endoscopy and Intraluminal Surgery
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Related Topics

  • ASCRS Webinars
  • Ulcerative Colitis: Surgical Management
  • Surgical Management of Ulcerative Colitis
  • Crohn’s Disease: Surgical Management
  • Surgical Management of Crohn's Disease

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