Our Summary

This research paper discusses the surgical treatments needed for most Crohn’s disease patients and some ulcerative colitis patients, despite advancements in diagnosis and therapy. The most common procedures involve removing parts of the bowel, repairing narrow sections of the bowel, diverting stool, or creating a small pouch from the small intestine. These surgeries significantly change the anatomy of the bowel. For patients with these bowel diseases, using endoscopy (a procedure to look inside the body) is crucial for monitoring disease activity, recurrence, treatment response, and for the delivery of therapy. However, endoscopy can be difficult when the bowel has been surgically altered. This paper provides a guideline for identifying anatomical markers and assessing these markers in diseased and surgically altered bowels through endoscopy.

FAQs

  1. What surgical procedures are most commonly done for patients with Crohn’s disease and ulcerative colitis?
  2. What is the role of endoscopy in the treatment of inflammatory bowel disease?
  3. What are the challenges in the endoscopic evaluation and management of surgically altered bowel?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow a proper diet and stay hydrated to promote healing and prevent complications. It is also important to follow your doctor’s instructions for post-operative care, including taking any prescribed medications and attending follow-up appointments. Additionally, maintaining a healthy lifestyle, including regular exercise and avoiding smoking, can help improve recovery after surgery. If you experience any concerning symptoms, such as persistent pain, fever, or changes in bowel habits, it is important to contact your healthcare provider.

Suitable For

Patients who are typically recommended bowel resection include those with:

  1. Severe or complicated cases of inflammatory bowel disease (Crohn’s disease or ulcerative colitis) that do not respond to medical therapy
  2. Bowel obstructions or strictures that cannot be managed conservatively
  3. Fistulas, abscesses, or other complications of inflammatory bowel disease
  4. Bowel perforation or significant intestinal bleeding
  5. Patients with a history of multiple surgeries for inflammatory bowel disease
  6. Patients with a high risk of developing colorectal cancer, such as those with long-standing ulcerative colitis
  7. Patients with complications from diverticulitis, such as perforation or abscess formation

It is important for patients to discuss the risks and benefits of bowel resection with their healthcare provider to determine if surgery is the best option for their individual situation.

Timeline

Before bowel resection:

  1. Patient experiences symptoms of inflammatory bowel disease such as abdominal pain, diarrhea, weight loss, and fatigue.
  2. Patient undergoes various diagnostic tests such as blood tests, imaging studies, and endoscopy to confirm the diagnosis and assess disease activity.
  3. Patient undergoes medical treatment including medications, dietary modifications, and lifestyle changes to manage symptoms and disease progression.
  4. Despite medical therapy, patient’s symptoms may not improve or may worsen, leading to the decision for surgical intervention.

After bowel resection:

  1. Patient undergoes bowel resection surgery to remove diseased segments of the intestine.
  2. Patient may have a temporary or permanent ostomy (ileostomy or colostomy) to divert stool away from the surgical site.
  3. Patient undergoes post-operative recovery period in the hospital, which includes pain management, wound care, and monitoring for complications.
  4. Patient gradually resumes normal activities and diet under the guidance of healthcare providers.
  5. Patient may need ongoing medical therapy, including medications and regular follow-up appointments, to prevent disease recurrence and monitor for complications.
  6. Patient may experience changes in bowel habits, digestion, and absorption of nutrients due to altered bowel anatomy, which may require dietary modifications and support from healthcare providers.

What to Ask Your Doctor

  1. What is the reason for recommending bowel resection as a treatment option for my condition?
  2. What are the potential risks and complications associated with bowel resection surgery?
  3. How long is the recovery period after bowel resection surgery and what can I expect during the recovery process?
  4. Will I need to make any lifestyle changes or dietary modifications after the surgery?
  5. What are the chances of the disease recurring after bowel resection surgery?
  6. Will I need any follow-up procedures or treatments after the bowel resection surgery?
  7. How will the surgery impact my bowel function and quality of life?
  8. Are there any alternative treatments or procedures that could be considered instead of bowel resection surgery?
  9. What is the success rate of bowel resection surgery in patients with my condition?
  10. How experienced is the surgical team in performing bowel resection surgeries for patients with inflammatory bowel disease?

Reference

Authors: Shen B, Kochhar GS, Navaneethan U, Cross RK, Farraye FA, Iacucci M, Schwartz DA, Gonzalez-Lama Y, Schairer J, Kiran RP, Kotze PG, Kobayashi T, Bortlik M, Liu X, Levy AN, González Suárez B, Tang SJ, Coelho-Prabhu N, Lukas M, Bruining DH, El-Hachem S, Charles RJ, Chen Y, Sood A, Mao R, Loras C, Dulai PS, Picoraro JA, Chiorean M, Lukas M, Shergill A, Silverberg MS, Sandborn WJ, Bernstein CN. Journal: Lancet Gastroenterol Hepatol. 2021 Jun;6(6):482-497. doi: 10.1016/S2468-1253(20)30394-0. Epub 2021 Apr 17. PMID: 33872568