By Dr. Ahmer Karimuddin and Gary Gilles
Crohn’s disease is an autoimmune disease that can cause inflammation in any part of your digestive or gastrointestinal tract. In the early stages of Crohn’s, medication may be recommended to manage symptoms. But if medication is not sufficient or complications arise from the progression of the disease, surgery may become necessary.
Many of the surgical procedures used to treat Crohn’s disease can be performed using laparoscopic surgery, which means less pain, less risk of infection and a shorter hospital stay. But not all Crohn’s disease patients are candidates for a laparoscopic procedure and a person’s suitability for this minimally invasive option is determined by your doctor on a case-by-case basis. Before surgery is considered or in combination with it, your doctor may appoint the following drugs groups available today:
TNF inhibitors
Access to TNF inhibitors is a major step forward. Note, however, that conventional therapy should have been tried and optimized (adequate metabolite levels) before you come to Canadian pharmacy or your supplier of choice for TNF inhibitors.
Current preparations are:
- Infliximab (Remicade, Remsima)
- Adalimumab (Humira)
- Golimumab (Simponi)
Integrin inhibitors
For example natalizumab and vedolizumab (Entyvio. It is now accepted that the combination of infliximab and a thiopurine is superior to treatment with either drug for IBD. It is still unclear how long the treatment will last and which preparation should be discontinued if single treatment is desired. Combination therapy with adalimumab is used more sparingly, due to less evidence than with infliximab therapy. TNF and integrin inhibitors should be used under the control of the patient’s symptoms and the burden of inflammation, in order to evaluate the duration and effect of treatment.
Considerations before surgery
Because every patient’s disease pattern is unique, you must form a plan that is designed to meet your individual needs. Before making a final decision, it’s helpful to understand why you may need surgery, to educate yourself about the different surgical options, and to ask questions of your doctor and surgeon. You also may want to speak with patients who have undergone the procedure you are considering. But, while it is important to become educated and exhaust all possible options before pursuing surgery, waiting too long could result in severe complications and/or malnourishment.
Surgery for Crohn’s disease is never a decision that should be taken lightly. All surgery carries some risks. Some risks are common to all surgeries and some are specific to the individual procedures. Ask your surgeon to explain all of the relevant risks associated with the procedure as they pertain to you and your individual condition. Abdominal surgery for Crohn’s disease carries risks related to healing, your incisions and the specific locations where intestines are put back together. Please discuss these in detail with your physicians.
Outside of emergency procedures, a decision to perform surgery should be made in collaboration with your doctor and surgeon. It’s important to seek out a surgeon who has significant experience working with Crohn’s disease. And don’t forget to think of yourself as part of your healthcare team. In fact, you are the most important member of your healthcare team and your voice counts as much as anyone’s.
- See how you compare to other people with Crohn’s disease. Take the test.
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