TY  - JOUR
A1  - Kelm, Matthias
A1  - Germer, Christoph-Thomas
A1  - Schlegel, Nicolas
A1  - Flemming, Sven
T1  - The revival of surgery in Crohn's disease — early intestinal resection as a reasonable alternative in localized ileitis
JF  - Biomedicines
N2  - Crohn's disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.
KW  - surgery
KW  - Crohn's disease
KW  - terminal ileitis
KW  - inflammatory bowel disease
KW  - surgical outcome
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246296
SN  - 2227-9059
VL  - 9
IS  - 10
ER  - 
TY  - JOUR
A1  - Kusan, Simon
A1  - Surat, Güzin
A1  - Kelm, Matthias
A1  - Anger, Friedrich
A1  - Kim, Mia
A1  - Germer, Christoph-Thomas
A1  - Schlegel, Nicolas
A1  - Flemming, Sven
T1  - Microbial spectrum and antibiotic resistance in patients suffering from penetrating Crohn's disease
JF  - Journal of Clinical Medicine
N2  - Intraabdominal abscess formation occurs in up to 30% of patients suffering from Crohn's disease (CD). While international guidelines recommend a step-up approach with a combination of empiric antibiotic therapy and percutaneous drainage to delay or even avoid surgery, evidence about microbial spectrum in penetrating ileitis is sparse. We retrospectively assessed outcomes of 46 patients with terminal penetrating Ileitis where microbial diagnostics have been performed and compared microbial spectrum and antibiotic resistance profile of CD patients with patients suffering from diverticulitis with intraabdominal abscess formation. In both groups, the most frequently isolated pathogen was the gram-negative bacterium E. coli belonging to the family of Enterobacterales. However, overall Enterobacterales were significantly more often verifiable in the control group than in CD patients. Furthermore, microbial analysis showed significant differences regarding isolation of anaerobic pathogens with decreased frequency in patients with CD. Subgroup analysis of CD patients to evaluate a potential influence of immunosuppressive therapy on microbial spectrum only revealed that Enterobacterales was less frequently detected in patients treated with steroids. Immunosuppressive therapy did not show any impact on all other groups of pathogens and did not change antibiotic resistance profile of CD patients. In conclusion, we were able to demonstrate that the microbial spectrum of CD patients does differ only for some pathogen species without increased rate of antibiotic resistance. However, the empiric antibiotic therapy for CD-associated intra-abdominal abscess remains challenging since different points such as local epidemiological and microbiological data, individual patient risk factors, severity of infection, and therapy algorithm including non-surgical and surgical therapy options should be considered before therapeutical decisions are made.
KW  - Crohn's disease
KW  - intraabdominal abscess
KW  - penetrating ileitis
KW  - microbial spectrum
KW  - antibiotic resistance
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-281835
SN  - 2077-0383
VL  - 11
IS  - 15
ER  -