In a patient with recurrent SBOs due to Crohn’s ileitis despite treatment with infliximab, do you consider switching to a different biologic versus resection?

The short answer is NO. Recurrent obstructions in Crohn’s disease are a mechanical problem, and they require a mechanical solution. Continuing medical therapy is a waste of time.

The answer is dependent on how much inflammatory activity is present.

If there is mostly fibrotic disease leading to the obstructions, then definitely recommend surgical resection. However if there is significant inflammatory activity then I will discuss both surgical resection *(based on LIRIC study data), vs switching to another advanced therapy. The most recent studies show anti-integrins and anti-interleukins work better with ileal disease compared to JAK inhibitors.

Heal with steel, then post-operative follow-up in 6 months to determine need for adjuvant treatment depending on genetic profiling.

Resect and monitor/treat post-op...