Should biologic agents be stopped before surgery for inflammatory bowel disease?

Expert Rev Gastroenterol Hepatol. 2015 Mar;9(3):269-72. doi: 10.1586/17474124.2015.975208. Epub 2014 Nov 4.


Despite the widespread use of anti-TNF agents for inflammatory bowel disease (IBD), the need for surgical intervention remains high. As a result, many IBD patients undergoing surgery have recently been exposed to biologic agents. There is considerable controversy regarding the potential adverse effects of biologic agents on surgical outcomes in IBD patients undergoing major colorectal surgery with studies showing conflicting results. There appears to be discordance in the systemic bioavailability of anti-TNF-α in patients with Crohn's disease (CD) versus ulcerative colitis, with greater systemic absorption in CD. In patients with CD, preoperative serum anti-TNF-α levels may help guide timing of surgery as patients with elevated serum anti-TNF-α levels appear to be at higher risk for complications. In patients with ulcerative colitis there is likely no need for stopping biologic agents before surgery as there is poor systemic bioavailability of the drug in a majority of patients.

Keywords: Crohn’s disease; anti-TNF; biologic; complication; drug level; surgery; ulcerative colitis.

Publication types

  • Editorial
  • Review

MeSH terms

  • Biological Factors / administration & dosage*
  • Biological Factors / blood
  • Colitis, Ulcerative / blood
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / surgery*
  • Crohn Disease / blood
  • Crohn Disease / drug therapy
  • Crohn Disease / surgery*
  • Humans
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Withholding Treatment*
  • Wound Healing / drug effects


  • Biological Factors
  • Tumor Necrosis Factor-alpha