Miguel Regueiro, MD, on Updates in Postoperative Crohn's Disease
Dr Regueiro reviews three major abstracts from Cleveland Clinic presented at DDW 2025 on postoperative Crohn's disease, including biomarker monitoring, the effect of previous anti-TNF exposure, and biologic therapy for older patients.
Miguel Regueiro, MD, is professor of medicine and chair of the Digestive Disease Institute at Cleveland Clinic in Cleveland, Ohio.
TRANSCRIPT:
I'm Dr. Miguel Regueiro, I'm Professor of Medicine and Chief of the Digestive Disease Institute at Cleveland Clinic in Cleveland, Ohio. Hopefully you enjoyed DDW 2025 as much as I did. We had a few blockbuster abstracts this year and three that I specifically want to outline are on our work on postoperative Crohn's disease.
Our group at Cleveland Clinic, but with other sites around the country, explored this important topic. I'd like to provide three of our separate presentations, the last one being actually something that was accepted for an oral plenary session.
But the first I'd like to outline is our postoperative effectiveness of biomarkers. Specifically, we looked at the cost-effectiveness of a biomarker monitoring strategy compared to endoscopic marker and monitoring and biologic experience postoperative Crohn's. The take-home message from this study is in our patients who underwent an ileocolonic resection, had a primary anastomosis, we used fecal calprotectin as the biomarker to monitor these patients. And then we looked at a cost strategy to see how cost was determined. What we found was that by using fecal calprotectin, this was a nice biomarker, noninvasive stool test that did measure inflammation early and allowed us to adjust our treatment accordingly. It doesn't replace fully colonoscopy, but it targets those patients who need a colonoscopy based on this biomarker. So this was cost effective and effective in general.
The next postoperative study that we looked at, which is an important topic, is prior TNF inhibitor exposure is not associated with endoscopic recurrence when we use a TNF inhibitor for postoperative prophylaxis after surgery. Simply put, what our study looked at were patients who underwent an ileocolonic resection, primary anastomosis for Crohn's disease, who had been on a TNF inhibitor in the past. Although they had been on a TNF inhibitor in the past, what we found is restarting a TNF inhibitor after the surgery actually prevented Crohn's disease in the future. So we can use the same TNF or a different TNF and it's essentially wiping the slate clean.
And then finally the postoperative Crohn's disease study that received an oral plenary award and we presented this as an oral abstract at DDW was looking at age and specifically older patients with Crohn's disease remain at high risk for postoperative recurrence and benefit from medical prophylaxis. What this means is and I think that there has been a theory that maybe our older patients who undergo surgery for Crohn's don't need to be put on a biologic or an advanced therapy. What we actually found were high rates of postoperative Crohn's in these patients over the age of 60. So we shouldn't use chronologic age to determine medications. So we should really treat everybody the same. And in these patients over 60, if they have a high risk for recurrence of Crohn's disease, we should start a biologic or an advanced therapy as we would at any age. Thank you very much.
Hopefully this postoperative Crohn's information was helpful. I hope you enjoyed DDW 2025.
