Surgery a viable first-line option for Crohn’s disease: doctors

Early ileocecal resection could be an effective first-line therapy for Crohn’s disease, according to Danish and US gastroenterologists, challenging the current paradigm of reserving surgery for complicated cases.

They suggest adults who underwent ileocecal resection post-diagnosis were 33% less likely to report adverse outcomes including hospitalisation and systemic corticosteroid exposure than those treated with anti-TNF therapy.

The team compared the long-term outcomes of nearly 1300 patients with ileal or ileocecal Crohn’s disease who underwent ileocecal resection or received anti-TNF therapy from 2003-18.

Two-thirds of the surgical cohort (mean age 30) underwent open ileocecal resection, while 90% of the anti-TNF cohort (mean age 22) received infliximab.

In addition to the main finding, half of those who underwent early surgery no longer required treatment at five years’ follow-up.

The authors said this “novel finding” suggested that timely ileocecal resection could have “a potentially curative role” for the right patient.

“This is in contrast to infliximab, following initiation of which, 18% needed an [ileocecal resection], 41% switched to a different biologic, and 47% continued on infliximab at five years,” they wrote in Gastroenterology.

They also found that the risk of Crohn’s disease-related hospitalisation or surgery was similar between treatment groups at one year follow-up, before increasing in the anti-TNF group.

But the authors said their findings likely underestimated the benefits of surgery.

“A large majority of patients in our study cohort underwent open surgery rather than laparoscopic surgery, which is likely to bias our results towards the null,” they wrote.

“With a shift towards laparoscopic surgery in recent times, outcomes are likely to be further improved.”

The results were limited, however, by the lack of data on clinical risk factors for disease progression.

More information: Gastroenterology 2023; 13 Jun.