Early Advanced Therapy and Postoperative Monitoring Emerge as Priorities in Updated Crohn’s Disease Guidance
Christina Ha, MD, FACG, outlined a structured approach to diagnosing, monitoring, and treating patients with an emphasis on early advanced therapy and risk-based postoperative management in a presentation at the 2025 Advances in IBD Annual Meeting.
Dr Ha is director of the Inflammatory Bowel Diseases Section at Mayo Clinic-Arizona in Scottsdale, Arizona.
She opened by defining the purpose of clinical guidelines: comprehensive frameworks designed “to help patients receive appropriate treatment and care based on the currently available evidence.” She emphasized that guidelines do not dictate strict sequencing but instead offer context and multiple therapeutic pathways based on effectiveness, safety, and patient-specific factors.
Dr Ha highlighted the complexity of therapeutic decision-making in Crohn’s disease due to the interplay between treatment efficacy, safety, individual characteristics, and disease phenotype. Clinicians must account for disease extent, behavior, severity, presence of extraintestinal manifestations, comorbidities, age, patient values, and pharmacologic considerations such as drug durability, therapeutic drug monitoring needs, and whether to use combination therapy.
Because Crohn’s disease is progressive for most patients—affecting 70% to 80% over time—Dr Ha underscored the importance of early recognition of high-risk features. These include large or deep ulcers, ileal or upper GI involvement, extensive or penetrating disease, perianal disease, young age at diagnosis, and extraintestinal manifestations. Dr Ha noted that symptoms alone are unreliable markers of disease activity. “Symptoms do not correlate with inflammatory disease activity,” she said, reinforcing the need for objective assessments to guide treatment and evaluate response.
The burden of Crohn’s disease extends beyond inflammation. Corticosteroid dependency remains common, with 25% of patients experiencing prolonged exposure. Up to 80% require hospitalization during their clinical course—most often in the first year—and 30% undergo surgery within 10 years of diagnosis. These complications contribute to substantial health care utilization, absenteeism, unemployment, and caregiver strain. Such data support the updated guidance recommendation of early initiation of advanced therapy rather than delaying escalation after disease progression. According to Dr Ha, “Treatment must be tailored to the individual needs of each patient,” with therapy selection incorporating disease severity, extent, location, and practical access considerations.
Postoperative management was another major focus. All patients with surgically induced remission should undergo endoscopic assessment at 6 to 12 months to detect recurrence early, Dr Ha stressed. Risk stratification drives subsequent decisions: low-risk patients—typically nonsmokers undergoing a first surgery for short-segment fibrostenotic disease—may be monitored without immediate therapy. High-risk patients, including those who smoke, have had prior resections, or present with penetrating disease, should receive anti-TNF therapy or vedolizumab to prevent postoperative endoscopic recurrence. Evidence for other mechanisms of action remains limited in this setting.
Dr Ha concluded with an emphasis on proactive rather than reactive care. Early advanced therapy in newly diagnosed patients and routine postoperative monitoring represent key strategies to reduce long-term complications, prevent recurrence, and mitigate the systemic burden of Crohn’s disease. For practicing gastroenterologists, Dr Ha’s message was clear: identify risk early, intervene promptly, and individualize therapy to achieve durable disease control.
Reference
Ha C. Crohn’s disease. Presented at: 2025 AIBD Annual Meeting. December 8-10, 2025.
