Crohn’s disease, a chronic inflammatory process of the gastrointestinal tract defined by flares and periods of remission, is increasing in incidence. Despite advances in multimodal medical therapy, disease progression often necessitates multiple operations with high morbidity. The inability to treat Crohn’s disease successfully is likely in part because the etiopathogenesis is not completely understood; however, recent research suggests the gut microbiome plays a critical role. How traditional perioperative management, including bowel preparation and preoperative antibiotics, further changes the microbiome and affects outcomes is not well described, especially in Crohn’s patients, who are unique given their immunosuppression and baseline dysbiosis. This paper aims to outline current knowledge regarding perioperative management of Crohn’s disease, the evolving role of gut dysbiosis, and how the microbiome can guide perioperative considerations with special attention to perioperative antibiotics as well as treatment of Mycobacterium avium subspecies paratuberculosis. In conclusion, dysbiosis is common in Crohn’s patients and may be exacerbated by malnutrition, steroids, narcotic use, diarrhea, and perioperative antibiotics. Dysbiosis is also a major risk factor for anastomotic leak, and special consideration should be given to limiting factors that further perturb the gut microbiota in the perioperative period.

中文翻译：

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克罗恩病手术治疗的围手术期注意事项以及手术抗生素实践和对肠道微生物组影响的讨论

克罗恩病是一种胃肠道慢性炎症过程，以发作和缓解期为特征，其发病率正在增加。尽管多模式药物治疗取得了进展，但疾病进展往往需要多次手术，且发病率很高。克罗恩病无法成功治疗的部分原因可能是其发病机制尚不完全清楚。然而，最近的研究表明肠道微生物组起着至关重要的作用。传统的围手术期管理（包括肠道准备和术前抗生素）如何进一步改变微生物组并影响结果尚不清楚，特别是在克罗恩病患者中，由于他们的免疫抑制和基线生态失调，这些患者是独一无二的。本文旨在概述有关克罗恩病围手术期管理、肠道菌群失调的演变作用以及微生物组如何指导围手术期注意事项的最新知识，特别关注围手术期抗生素以及鸟分枝杆菌亚种副结核病的治疗。总之，克罗恩病患者中菌群失调很常见，营养不良、类固醇、麻醉品使用、腹泻和围手术期抗生素可能会加剧菌群失调。生态失调也是吻合口瘘的主要危险因素，应特别考虑围手术期进一步扰乱肠道微生物群的限制因素。