title: Should biologic agents be stopped before surgery for inflammatory bowel disease?
abstract: Despite the widespread use of anti-TNF agents for inflammatory bowel disease (IBD), the need for surgical intervention remains high. As a result, many IBD patients undergoing surgery have recently been exposed to biologic agents. There is considerable controversy regarding the potential adverse effects of biologic agents on surgical outcomes in IBD patients undergoing major colorectal surgery with studies showing conflicting results. There appears to be discordance in the systemic bioavailability of anti-TNF-α in patients with Crohn's disease (CD) versus ulcerative colitis, with greater systemic absorption in CD. In patients with CD, preoperative serum anti-TNF-α levels may help guide timing of surgery as patients with elevated serum anti-TNF-α levels appear to be at higher risk for complications. In patients with ulcerative colitis there is likely no need for stopping biologic agents before surgery as there is poor systemic bioavailability of the drug in a majority of patients.
authors.affiliation: Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Zaghiyan
authors.forename: Dermot
authors.initials: D
authors.lastname: McGovern
authors.forename: Phillip
authors.initials: P
authors.lastname: Fleshner
mesh_terms: D001685:Biological Factors / Q000008:administration & dosage* / Q000097:blood; D003093:Colitis, Ulcerative / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment; D014945:Wound Healing / Q000187:drug effects
chemical_list: D001685:Biological Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Crohn’s disease; anti-TNF; biologic; complication; drug level; surgery; ulcerative colitis