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Clin Colon Rectal Surg 2022; 35(01): 072-077
DOI: 10.1055/s-0041-1740031
Review Article

Surgery versus Medical Therapy in Luminal Ileocecal Crohn's Disease

Michele Carvello
1   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
2   Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Silvio Danese
1   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
3   Department of Gastroenterology, IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Antonino Spinelli
1   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
2   Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
› Author Affiliations Funding None.
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Abstract

The deeper understanding of the inflammatory process which gradually evolves into irreversible fibrosis and tissue damage has provided a precise picture of the disease course of luminal ileocecal Crohn's disease. According to the model of progressive structural damage, ideal time windows for medical and surgical treatment have been identified. While complicated disease clearly profits from surgical treatment, uncomplicated disease has become, in the last years, the most debatable setting in terms of different approaches including early surgery. On one hand, the rationale of traditional escalating medical therapy (step-up approach) has been undermined by the top-down medical approach. Indeed, the step-up approach has the possible drawback of delaying, up to a later disease stage, the use of more effective agents such as anti-tumor necrosis factors. Conversely, the top-down approach might expose patients to an overtreatment along with side effects including hypersensitivity to biologic agents. More recently, it has been shown how early surgery could be a valid option in this subset of patients being more cost-effective than medical therapy. Involving the surgeon at an early stage is considered now a good clinical practice and, in this scenario full of possibilities, the surgeon should be included into the decision-making process from the very beginning of patient management.

Keywords

surgery - ileocectomy - Crohn's disease - top-down

Authors' Contributions

M.C. revised the literature and drafted the manuscript, S.D. and A.S. critically revised the manuscript.




Publication History

Article published online:
17 January 2022

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