In the lead up to Barcelona 2014, we interviewed Dr Feza H Remzi who presented his keynote lecture 'Timing of Surgery in Crohn’s disease'...
In the United States there are approximately one million patients with Crohn’s disease, including those with colitis, according to Dr Remzi, Chairman, Department of Colorectal Surgery, Digestive Disease Institute, Cleveland, OH. Crohn’s disease usually impacts patients aged from their early teens to their late twenties, although it can affect patients of any age.
“The etiology of the disease is multifactorial and there is definitely a genetic affect, an environmental affect and potential other affects that as yet are unknown,” he explained. “What is known is that something is happening within the system that riggers the body’s immune system to attack the gut lining, which creates this cascade of events.”
Although medical therapy is the primary treatment for Crohn’s disease, over 90% of patients require some surgical consultation or treatment at some time. As a consequence, Remzi explained that it is imperative that the surgical team is part of the care-giver team.
“Unfortunately, I think there is a universal opinion that surgery is unnecessary because there can be a recurrence of the disease,” he said. “However, this view can be detrimental to the patient’s outcomes as they delay seeing a surgeon, who could surgically manage their minor complications, by the time they visit their surgeon the minor complications have become more complex.”
Quality of life
With regards to surgery, Dr Remzi said that the wishes of the patient are paramount. He explained that in the case of an ileostomy or a colostomy, these are procedures that will impact their quality of life and day-to-day lives.
“As surgeons our role is not to impose surgery, but to fully explain what surgery will mean and prepare the patients for both the surgery and their life afterwards,” he added. “This includes meeting the multi-disciplinary team and making them part of the decision-making process, and helping them to get support from patient associations. Crohn’s disease is not like cancer where surgery is really a ‘take it or leave it’ situation, it is about them managing their quality of life as best they can.”
Over the last decade he said that the surgical aspect of care has evolved from treating the pathology to being more patient focused and he added that as physicians, surgeons were now ‘better’ at listening to the needs of patients but that there was still room for ‘improvement’.
He said that he and his surgical colleagues work on several aspects of the patient’s treatment and cited medical management as one area which they work with other specialties before and after surgery, to impact the recurrence rate and reduce a patient’s complications.
“In the US, we are fortunate enough to have the wonderful Crohn's and Colitis Foundation of America (CCFA), and the leadership invite the surgeons to their meetings and this has been a very important development because it brings us closer to our patients, both in terms of communication and understanding,” said Dr Remzi. “Hopefully, by becoming involved in such networks we can see fewer patients delay surgery, receive treatment earlier and, hopefully, together we can manage their condition.”