Rachel Fieldhouse EARLY ileocecal resection could be an effective first-line therapy for Crohn ’ s disease , according to gastroenterologists , challenging the current paradigm of reserving surgery for complicated cases .

They suggest adults who undergo ileocecal resection post-diagnosis are 33 % less likely to report adverse outcomes , including hospitalisation and systemic corticosteroid exposure than those treated with anti-TNF therapy .

The Danish and US team compared the long-term outcomes of nearly 1300 patients with ileal or ileocecal Crohn ’ s disease who underwent ileocecal resection or received anti-TNF therapy from 2003 to 2018 .

Two-thirds of the surgical cohort ( mean age 30 ) underwent open ileocecal resection , while 90 % of the anti-TNF cohort ( mean age 22 ) received infliximab .

In addition to the main finding , half of those who underwent early surgery no longer required treatment at five years ’ follow-up .

This “ novel finding ” suggested that timely ileocecal resection

could have a potentially curative role for the right patient , the authors said .

“ This is in contrast to infliximab , following initiation of which , 18 % needed an [ ileocecal resection ], 41 % switched to a different biologic and 47 % continued on infliximab at five years ,” they wrote in Gastroenterology .

They also found that the risk of Crohn ’ s disease – related hospitalisation or surgery was similar between treatment groups at oneyear follow-up before increasing in the anti-TNF group .

But the authors claimed their findings likely underestimated the benefits of surgery .

“ A large majority of patients in our study cohort underwent open surgery rather than laparoscopic surgery , which is likely to bias our results towards the null ,” they wrote .

“ With a shift towards laparoscopic surgery in recent times , outcomes are likely to be further improved .”

The results were limited , however , by the lack of data on clinical risk factors for disease progression . Gastroenterology 2023 ; 13 Jun .

FROM PAGE 1 An IMG , Dr Patel was originally sentenced to seven years in prison following the death of a patient . He was subsequently acquitted of manslaughter at a retrial and released .

But Dr Glenn , a GP working in rural Victoria , said the demands that every specialist IMG should have to work under supervision before being granted specialist registration was excessive .

An Australian citizen , she was one of the first graduates from Notre Dame University ’ s School of Medicine in WA and completed her junior doctor training in Perth . But when her father died , she moved to New Zealand so her son could grow up with his paternal cousins .

She eventually secured a fellowship from the Royal New Zealand College of General Practitioners ( RNZCGP ) at a time when the qualification was recognised as equivalent to an FRACGP .

But after the Medical Board of Australia put out standards saying all specialist IMGs should work under supervision , in 2019 the RACGP ditched its reciprocal arrangements .

Dr Corinne Glenn .

To prove to the RACGP that her training was ‘ substantially comparable ’, Dr Glenn said she had to provide the college with her curriculum , including assessments , as well as a letter from the RNZCGP to back up the assessments .

‘ It caused great financial difficulty for me .’

“ You also have to go through an Australian Medical Council and AHPRA process as well ,” she says . “ Each step costs money .” The assessments took nine months , then Dr Glenn had to pay $ 9000 to join the RACGP ’ s Practice Experience Program specialist pathway to work under supervision .

“ I ’ ve spent well over $ 10,000 . It ’ s insanely expensive .”

The level of support offered on the pathway was minimal , she claimed .

“ If I was doing the Australian GP Training Program , I would have access to training materials , such as Therapeutic Guidelines , but in the independent specialist program , you are not eligible for them .

“ I landed in a practice that was not suitable ; there was not enough work , and I often had 10-12 free appointments a day . It caused significant financial difficulty for me . There are no protections like minimum salary .”

But Professor Clements , who has supervised GPs in similar situations , defended the college ’ s mandatory supervision rule .

“ General practice is one of the hardest specialties , yet once fellowship is bestowed , you can set up by yourself with nobody supporting you . “ I don ’ t think it ’ s appropriate to have GPs working in our system without any training in Medicare or the PBS to be left alone .

“ I can ’ t think of any other specialty that puts their [ doctors ] in such a vulnerable position .

“ As it stands , someone who has done a very similar fellowship overseas is only required to undergo six months of transition .

“ I know many [ IMGs ] see it as a barrier , but it should be seen as a protection . My view , and the college ’ s view , is that it ’ s appropriate .”