Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support
Patients with inflammatory bowel disease (IBD) commonly require surgery despite the availability of an increasingly large repertoire of powerful immunosuppressive medications for the treatment of IBD. Optimizing patients’ care preoperatively is crucial to obtaining good surgical outcomes. This revie...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/7890161 |
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| author | Patrick L. Stoner Amir Kamel Fares Ayoub Sanda Tan Atif Iqbal Sarah C. Glover Ellen M. Zimmermann |
| author_facet | Patrick L. Stoner Amir Kamel Fares Ayoub Sanda Tan Atif Iqbal Sarah C. Glover Ellen M. Zimmermann |
| author_sort | Patrick L. Stoner |
| collection | DOAJ |
| description | Patients with inflammatory bowel disease (IBD) commonly require surgery despite the availability of an increasingly large repertoire of powerful immunosuppressive medications for the treatment of IBD. Optimizing patients’ care preoperatively is crucial to obtaining good surgical outcomes. This review discusses preoperative assessment and management principles including assessing disease location and activity with cross-sectional or endoscopic imaging, addressing modifiable risk factors (i.e., stopping smoking, weaning steroids, and correcting anemia), and properly managing medications. The major focus of our literature review is the evaluation for malnutrition, a common finding that affects up to 70% of patients with IBD and a well-known, independent risk factor for adverse postoperative outcomes. Our review confirms that whenever feasible, oral or enteral nutrition (EN) is the preferred method of nutritional support; parenteral nutrition (PN) should be reserved for nutritionally deficient IBD patients unable to tolerate EN. In selected patients, recent data demonstrated that the use of preoperative PN resulted in improved nutritional status, fewer postoperative complications, and reduced disease severity. Our review highlights the need for well-designed, prospective trials investigating perioperative nutritional support in patients with IBD. Future studies should perform modern nutritional assessment, standardize for diet, and include patients with UC since this subset of patients is underrepresented in existing studies. In addition, relevant outcome of interest specific to Crohn’s disease (CD) patients such as length of small bowel resected, number of anastomoses, and need for an ostomy should be included as these patients may require repeated small bowel resections. |
| format | Article |
| id | doaj-art-026e35d9e07a46b3855bcae0df838f53 |
| institution | OA Journals |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-026e35d9e07a46b3855bcae0df838f532025-08-20T02:01:49ZengWileyGastroenterology Research and Practice1687-61211687-630X2018-01-01201810.1155/2018/78901617890161Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional SupportPatrick L. Stoner0Amir Kamel1Fares Ayoub2Sanda Tan3Atif Iqbal4Sarah C. Glover5Ellen M. Zimmermann6Department of Medicine, Division of Gastroenterology, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USADepartment of Pharmacotherapy, College of Pharmacy, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USADepartment of Medicine, Division of Gastroenterology, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USADepartment of Surgery, Division of Colorectal Surgery, College of Medicine, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USADepartment of Surgery, Division of Colorectal Surgery, College of Medicine, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USADepartment of Medicine, Division of Gastroenterology, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USADepartment of Medicine, Division of Gastroenterology, University of Florida, 2000 SW Archer Rd, Gainesville, FL 32610, USAPatients with inflammatory bowel disease (IBD) commonly require surgery despite the availability of an increasingly large repertoire of powerful immunosuppressive medications for the treatment of IBD. Optimizing patients’ care preoperatively is crucial to obtaining good surgical outcomes. This review discusses preoperative assessment and management principles including assessing disease location and activity with cross-sectional or endoscopic imaging, addressing modifiable risk factors (i.e., stopping smoking, weaning steroids, and correcting anemia), and properly managing medications. The major focus of our literature review is the evaluation for malnutrition, a common finding that affects up to 70% of patients with IBD and a well-known, independent risk factor for adverse postoperative outcomes. Our review confirms that whenever feasible, oral or enteral nutrition (EN) is the preferred method of nutritional support; parenteral nutrition (PN) should be reserved for nutritionally deficient IBD patients unable to tolerate EN. In selected patients, recent data demonstrated that the use of preoperative PN resulted in improved nutritional status, fewer postoperative complications, and reduced disease severity. Our review highlights the need for well-designed, prospective trials investigating perioperative nutritional support in patients with IBD. Future studies should perform modern nutritional assessment, standardize for diet, and include patients with UC since this subset of patients is underrepresented in existing studies. In addition, relevant outcome of interest specific to Crohn’s disease (CD) patients such as length of small bowel resected, number of anastomoses, and need for an ostomy should be included as these patients may require repeated small bowel resections.http://dx.doi.org/10.1155/2018/7890161 |
| spellingShingle | Patrick L. Stoner Amir Kamel Fares Ayoub Sanda Tan Atif Iqbal Sarah C. Glover Ellen M. Zimmermann Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support Gastroenterology Research and Practice |
| title | Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support |
| title_full | Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support |
| title_fullStr | Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support |
| title_full_unstemmed | Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support |
| title_short | Perioperative Care of Patients with Inflammatory Bowel Disease: Focus on Nutritional Support |
| title_sort | perioperative care of patients with inflammatory bowel disease focus on nutritional support |
| url | http://dx.doi.org/10.1155/2018/7890161 |
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