Medical Management of Surgical Inflammatory Bowel Disease? Current Concepts and Future Possibilities

Successful long-term management of patients with inflammatory bowel disease (IBD) requires communication and interaction between medical physicians and surgeons. With the advent of biologic therapies in IBD, our definition of “medical” and “surgical” IBD has been refined. This article will discuss potential roles of biologic therapies in three clinically important subgroups of IBD considered to be the primary domain of the surgeon: fistulizing Crohn's disease (CD), stricturing CD, and severe ulcerative colitis (UC). Tumor necrosis factor inhibitors and other biologics in clinical trials are likely to have an increasingly important role in fistulizing CD and severe UC. Furthermore, the optimal clinical application of new biologics necessitates that surgeons are closely involved in patient management. Therefore, the introduction and development of biologic therapies in IBD present new opportunities to avoid surgery in select patients, but close interactions between the gastroenterologist and the surgeon remain essential.