Work

Predictors, risk factors and management of intestinal failure in crohn’s disease: A narrative review

Year: 2026

Type: review

Abstract: Intestinal failure in Crohn's disease is a preventable complication arising from primarily three pathways: progressive inflammatory bowel destruction, cumulative surgical loss, and postoperative septic complications. Crohn's disease is one of the most common benign causes, with a cumulative incidence of approximately 8.5% at 20 years after initial surgery. Postoperative abdominal sepsis accounts for over half the cases, highlighting the importance of perioperative optimization. Several predictors such as young age at diagnosis, penetrating disease behavior, upper gastrointestinal localisation, cumulative inflammatory burden, residual small intestinal length less than 200 cm, and non-use of biologic therapy. Prevention should be the focus of management. Modern treat-to-target interventions aiming for endoscopic and transmural healing, early effective biologic therapy, timely surgical intervention with bowel-sparing techniques including strictureplasty and the Kono-S anastomosis, and structured perioperative optimization with nutritional rehabilitation collectively address each of the three pathways to intestinal failure. Management of established intestinal failure requires multidisciplinary intestinal rehabilitation encompassing parenteral nutrition, pharmacological intestinotrophic therapy with glucagon-like peptide-2 agonists, active Crohn's disease management, autologous gastrointestinal reconstruction and intestinal transplantation in refractory cases. This narrative review synthesizes the current evidence through unifying framework that intestinal failure in Crohn's disease is preventable at each step of the disease trajectory and proposes a risk stratification model and management algorithm to guide clinical decision making.

Source: Intestinal failure.

DOI: 10.1016/j.intf.2026.100400

Authors: Dhruvi Shah, Meena Alzamani, Tanisha Sehgal, Vishal Sharma, Manjeet Kumar Goyal

Institutions: University of Maryland Medical Center, University of Maryland Medical Center Midtown Campus, Dayanand Medical College & Hospital, Post Graduate Institute of Medical Education and Research, Cleveland Clinic Akron General

Language: English

Topic: Inflammatory Bowel Disease

Subfield: Genetics

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,750