The Clinical Practice Guideline Committee's newest guideline, Clinical Practice Guideline for the Surgical Management of Crohn's Disease, has been published in the November issue of Diseases of the Colon and Rectum.
Crohn’s disease is a chronic, unremitting, incurable inflammatory disorder that can affect any segment of the intestinal tract, as well as extraintestinal sites. Disease behavior is classified as nonstricturing, nonpenetrating (ie, inflammatory), fibrostenotic, or penetrating, and is prone to change over the course of the disease. Approximately 19% to 38% of patients have stricturing or penetrating complications at the time of diagnosis, whereas ~61% to 88% of patients will have developed these manifestations after 20 years of disease. Although the etiology of Crohn’s disease remains unknown, the disease likely results from a complex interplay between conditioning factors (eg, genetics, triggering events) and effector mechanisms that lead to a dysregulation of both intestinal immune and nonimmune functions.
Before the introduction of anti-tumor necrosis factor (TNF) medications, population-based cohorts from Canada, Denmark, Norway, Sweden, the United States, and Wales reported that surgical intervention is performed in 27% to 61% of patients with Crohn’s disease within 5 years of diagnosis. Independent risk factors associated with undergoing an initial surgery (versus reoperation) according to similar population-based cohorts include current tobacco usage, disease location, stricturing or penetrating disease behavior, and (although somewhat controversial) the early use of high-dose glucocorticoids or immunomodulators. This clinical practice guideline will focus on the surgical management of patients with Crohn’s disease.
This publication is a revision of the 2007 guideline of the same name. Read the full guideline now.
To review the full November 2015 issue, log in to your member account at the top of the page and then follow the DC&R link.