The Role of Genetics in the Surgical Management of Inflammatory Bowel Disease

The relatively recent discoveries of >100 genes potentially involved with the etiology of inflammatory bowel disease (IBD) have stimulated intense research. The study of the pathophysiologic consequences of defects in these genes and the potential for a more careful classification of IBD patients based on genotype are two evolving benefits of this newfound knowledge. However, the use of such genetic information in the clinical care of IBD patients, especially in the surgical field, has lagged. There are many unresolved surgical issues in IBD management that hold hope for improvement through the use of genetic information in the individual patient. This includes, for example, identifying Crohn's disease patients at increased risk for recurrence after surgery to institute earlier prophylactic measures or maximize the use of bowel length preserving procedures. In the case of ulcerative colitis, genetics may help in preoperative patient selection by predicting which patients might suffer from severe pouchitis or pouch-threatening complications, such as fistuli or strictures. Similarly, the imperfect ability of colonoscopy to identify colitic patients who develop cancer may be solved by genetic markers that would predict malignant degeneration and so allow more effective prophylactic surgery.