Modern strategies of therapeutic and surgical treatment of Crohn’s disease

Purpose of the study. Analysis of the results of recent studies of BC with the aim of understanding the possibility of changing or modifying the natural course of BC with therapeutic or surgical methods, the possibility of a complete cure of BC with therapeutic methods.

Materials and methods. This review examines the results of recent studies aimed at studying the eff ect of modern therapeutic methods for treating CD for the course of this disease and the possibility of reducing the number of surgical interventions.

Results. The concept of competent therapeutic treatment of BC in the long term (more than 7 years) has not been confi rmed. The accumulating experience of repeated bowel resections in patients with CD, suggests that the phenotype of the disease in the re-operated patients with CD remains the same, regardless of the nature of the treatment. However, the risk of surgical interventions in patients with CD in recent years has decreased.

Conclusion. Early diagnosis (CT, MRI) and the earlier treatment of complications instead of prescribing therapeutic treatment, eff ective prevention of relapses with modern drugs in the postoperative period leads to the fact that recently there has been a decrease in the risk of surgical interventions in patients with CD. Surgical strategy is aimed at the use of “economical” resections with the formation of the primary small-intestinal or small-colonic anastomosis in an open way.

1. Luther J., Dave M., Higgins R. et al. Association between Helicobacter pillory and inflammatory bowel disease: a meta- analysis and systematic review of the literature. Infl am. Bow.Dis. 2010, vol.16, pp.1077–1084.

2. Maev I. V., Andreev D. N., Dicheva D. T., Velikanov E. V. Bolezn’ Krona: etiopatogenez, diagnostika i konservativnoe lechenie. [Crohn’s disease: etiopathogenesis, diagnosis and conservative treatment]. Moscow, Prima Print, 2016. 67 p.

3. Burisch J, Jess T, Martinato M, et al. The burden of inflammatory bowel disease in Europe. J. Crohns Colitis, 2013, no.7, pp.322–337.

4. White J.R, Phillips F, Monaghan T, et. al. Novel Oral–targeted Therapies in Inflammatory Bowel Disease. Aliment. Pharmacol. Ther, 2018, no.47(12), pp.1610–1622.

5. Li Yi, Zhu Weiming, et al. Frequency and risk factors of postoperative recurrence of Crohn’s Disease after intestinal resection in the Chinese population. J Gastrointest Surg, 2012, pp.1539–1547.

6. Rutgeerts Paul Strategies in the prevention of post-operative recurrence in Crohn’s disease. Best Practice and Research Clinical Gastroenterology, 2003, vol.17, no.1, pp. 63–73.

7. Schnitzler F., Fidder H., Ferrante M. et al. Long-term outcome of treatment with infl iximab in 614 patients with Crohn’s disease: results from a single-centre cohort. Gut, 2009, vol.58, pp.492–500.

8. Vermeire S.; G. Van Assche; P. Rutgeerts Altering the Natural History of Crohn’s Disease. Evidence for and Against Current Therapies Aliment Pharmacol Ther, 2007, no.25(1), pp.3–12.

9. Wintjens DSJ, Bogie RMM et al. Incidence and Classification of Postcolonoscopy Colorectal Cancers in Infl ammatory Bowel Disease: A Dutch PopulationBased Cohort Study. Crohns Colitis, 2018 – P. 34.

10. Chassaing B, Koren O, Goodrich JK, et al. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature, 2015, vol.519, pp.92–96.

11. Dibley L, Czuber-Dochan W., et al. Patient DecisionMaking About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives. Infl ammatory Bowel Diseases, 2018, no. 24(2), pp. 235–246.

12. Pershko A. M., Grinevich V. B., Solovyov I. A., Shotik A. V., Kurilo D. P. Private the pathogenesis of inflammatory bowel diseases. Experimental and Clinical Gastroenterology. 2018;153(05):140–149

13. Ahmad T, Armuzzi A, Bunce M, Mulcahy-Hawes K, Marshall SE et al. The molecular classification of the clinical manifestations of Crohn’s disease. Gastroenterology, 2002, no.122(4), pp854–66.

14. Gajendran M, Loganathan P, et al. A comprehensive review and update on Crohn’s disease. Dis Mon, 2018, pp.20–57.

15. Leombruno JP, et al. Hospitalization and surgical rates in patients with Crohn’s disease treated with infliximab: a matched analysis. Pharmacoepidemiol Drug Saf, 2011.

16. Khanna R, Bressler B, Levesque BG, et al. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial. Lancet. 2015, vol.386, pp.1825–1834.

17. Yamamoto T. and Watanabe T. Strategies for the prevention of postoperative recurrence of Crohn’s disease. The Association of Coloproctology of Great Britain and Ireland, 2013, pp.1471–1480.

18. Wu GD, Compher C, Chen EZ, et al. Comparative metabolomics in vegans and omnivores reveal constraints on diet-dependent gut microbiota metabolite production. Gut, 2014, vol.65, pp.63–72.

19. Eberhardson M., Ludvigsson J. F., Soderling J. K. et al. Anti-TNF treatment in Crohn’s disease and risk of bowel resection – a population based cohort study. Aliment Pharmacol Ther, 2017, no.46, pp.589–598.

20. Kotze PG, Magro DO, et.al. Long time from diagnosis to surgery may increase postoperative complication rates in elective CD intestinal resections: an observational study. Gastroenterol Research and Practice, 2018, pp.1435–1443.

21. Pariente B., Cosnes J., Danese S., et al. Development of the Crohn’s disease digestive damage score, the Lémann score. Inflammatory Bowel Diseases, 2011, no.17(6), pp. 1415–1422.

22. Lloyd-Price J., Abu-Ali G., Huttenhower C. The healthy human microbiome. Genome Med, 2016, no.8, pp.51–54.

23. Rieder F, Fiocchi C, Rogler G. Mechanisms, management, and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology, 2017, no.152, pp.340–50

24. Hildebrandt MA, Hoff mann C, Sherrill-Mix SA, et al. High-fat diet determines the composition of the murine gut microbiome independently of obesity. Gastroenterology, 2009, vol.137, pp.1716–1724.

25. Henckaerts L, Van Steen K, Verstreken I, Cleynen I, Franke A, Schreiber S, et al. Genetic risk profi ling and prediction of disease course in Crohn’s disease patients. Clin Gastroenterol Hepatol, 2009, № 7(9), pp.972–980.

26. Hugot J-P, Chamaiilard M, Zouali H et al. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn’s disease. Nature, 2001, vol.411, pp. 599–603.

27. Chassaing B, Van de Wiele T, De Bodt J, et al. Dietary emulsifiers directly alter human microbiota composition and gene expression ex vivo potentiating intestinal inflammation. Gut, 2017, vol.66, pp.1414–1427.

28. Hugot J-P, Laurent-Puig P, Gower-Rousseau C et al. Mapping of a susceptibility locus for Crohn’s disease on chromosome 16. Nature, 1996, vol. 379, pp. 821–823.