Complications and surgery in the inflammatory bowel diseases biological era.
OBJECTIVE
Therapy for inflammatory bowel diseases (IBD) has changed dramatically in recent years with a wider use of immunomodulators and the introduction of antitumor necrosis factor (anti-TNF) agents. This article reviews the existing data on the long-term efficacy of biologics, that is, anti-TNF agents, for preventing complications and surgery in patients with IBD.


RESULTS
Anti-TNF agents are effective for preventing endoscopic and surgical recurrence after surgery for Crohn's disease. They are able to achieve fistula closure and do not increase the risk of stricture. Most randomized short-term trials also showed decreased requirement for hospitalizations and surgery in patients receiving anti-TNF. However, observational studies from referral centers or based on population have shown conflicting results. The need for surgery in Crohn's disease and the risk of colectomy in ulcerative colitis seem to be decreasing in recent years, but the specific effect of the introduction of anti-TNF agents cannot be currently evaluated.


CONCLUSIONS
Although anti-TNF agents are the most powerful drugs in IBD, their ability to decrease the need for surgery remains unclear. Conflicting results observed in observational surveys might be because of anti-TNF agents administered too late in the course of IBD.
Service de Gastroentérologie et Nutrition, Hôpital St-Antoine, et Université Paris VI, Paris, France.
Harry
H
Sokol
Philippe
P
Seksik
Jacques
J
Cosnes
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012074:Remission Induction; D055502:Secondary Prevention; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha