John Damianos, M.D. Profile picture
@MayoClinicGIHep Gastroenterology & Hepatology Fellow. Yale Internal Medicine, Dartmouth Med. Microbiome, probiotics, brain-gut, diet, motility, IBD, MedEd 🇬🇷

Oct 24, 2021, 19 tweets

Management of post-op Crohn disease with @MRegueiroMD at @AmCollegeGastro #ACG2021

#GITwitter #IBD

The natural course of postoperative Crohn disease: it keeps progressing

Rutgeert score

How do we prevent recurrence?

1. microbiome (antibiotics, diet)
2. biologics

Data for #probiotics, steroids have not panned out

Metronidazole can prevent, but once we stop, Crohn's creeps up again

How about early biologic treatment?

What about watchful waiting and treating recurrence?
♦️ ♣️ ♥️ 🃏 POCER trial (appropriate here at #LasVegas #ACG2021!)

Preop anti-TNF does NOT ⬆️ postop infection risk!

Infliximab and adalimumab used early postop can prevent recurrence.

New surgical approaches to prevent recurrence ✂️

Does anastamotic ulceration lead to worse long-term outcomes?

💎s from @MRegueiroMD on prevention of postoperative Crohn disease recurrence

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