The effect of immunomodulators and biologics on indication for surgical bowel resection in children with Crohn's disease.
BACKGROUND
Despite advances in medical therapies, many children with Crohn's disease (CD) will require bowel resection. Although previous registry studies have attempted to identify risk factors for surgery, the effect of immunomodulators and biologics (IMB) on surgical indications has not been well characterized.


METHODS
We reviewed a series of 125 children with CD who underwent bowel resection with reanastomosis between 1977 and 2011 and were followed up for at least 6 months. We compared patients who underwent surgery for perforating disease (abscess or internal fistula) and patients who were operated on for medically refractory or fibrostenosing disease. Between these 2 groups, we examined medications received before surgery. Other demographic and disease-specific covariates were examined.


RESULTS
Of the 82 patients who received IMB before surgery, only 19 patients (23%) required surgery for a perforating complication of CD, whereas 63 patients (77%) required surgery for strictures or medically refractory disease. In contrast, of the 43 patients who did not receive IMB preoperatively, 20 patients (45%) developed a perforating complication and 23 patients (53%) required surgery for strictures or refractory disease. These differences across groups were significant, with a lower rate of operation for perforating disease among patients receiving preoperative IMB therapy (P = 0.007).


CONCLUSIONS
In our surgical cohort, children with CD who were treated with IMB were less likely to have surgery for perforating disease. This finding raises the possibility that the administration of IMB in children who require surgery may be associated with a difference in disease behavior.
*Center for Inflammatory Bowel Disease, Boston Children's Hospital, Boston, MA; †Department of Surgery, Boston Children's Hospital, Boston, MA; ‡Clinical Research Program, Boston Children's Hospital, Boston, MA; and §Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA.
Lori A
LA
Zimmerman
Robert C
RC
Shamberger
Clarissa
C
Valim
Athos
A
Bousvaros
D000293:Adolescent; D000328:Adult; D001688:Biological Products / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007412:Intestinal Fistula / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D007422:Intestines / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
D001688:Biological Products; D007155:Immunologic Factors