Immunosuppressive therapy and perioperative management in inflammatory bowel disease

―except for corticosteroid―

Abstract

In the treatment of inflammatory bowel disease, various types of immunosuppressive therapies are performed. Post-operative infectious complications may become a problem in IBD patients receiving immunosuppressive therapies. Many studies have been carried out about the influence of these immunosuppressive therapies on early postopera-tive complications. Postoperative complications after surgery for IBD are not associated with the use of azathio-prine/6-mercaptopurine or calcineurin inhibitors, but are associated with the steroid use and prolonged medical therapy before surgery. Increasing preoperative serum anti-TNFalpha antibody levels are associated with postop-erative complications in Crohn disease patients, but not in ulcerative colitis patients. As for the other biological and molecular-targeted therapies, there are few studies about the association of these therapies and postoperative com-plications. In perioperative management of the patients with IBD receiving immunosuppressive therapies, it is im-portant to perform adequate preventive measures including preoperative oral administration of antibiotics for the prevention of SSI. In addition, the prevention of opportunistic infection such as pneumocystis pneumonia by adminis-tration of trimethoprim-sulfamethoxazole is also important.