Biological Therapy for Inflammatory Bowel Diseases: Screening Prior to Initiating and How to Proceed When Surgery Is Necessary

Biological therapy has revolutionized the management of inflammatory bowel disease (IBD) in the last 30 years. However, these drugs have side effects and adverse events. Before starting this therapy, it is necessary to screen for specific infectious diseases and monitoring protocols. Screening for human immunodeficiency virus, hepatitis C, hepatitis B, and Mycobacterium tuberculosis infections must be included. In addition, vaccination should be checked and updated if necessary. Despite the advent of biological therapy, a significant number of patients with IBD will need surgery in their lifetime due to either clinical intractability or disease complications. Many of them will be on biological therapy, and there is a consider-able controversy about adverse effects of biologics on surgical outcomes. In this chapter, we will approach the screening required to start this therapy and how to proceed when surgery is necessary in these patients.