Predictors, risk factors and management of intestinal failure in crohn’s disease: A narrative review
4 affiliations
- 1Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, 21201, United States
- 2Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
- 3Additional Professor of Gastroenterology, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- 4Cleveland Clinic Akron General, Akron, OH, 44307, United States; Correspondence to: Department of Internal Medicine, Cleveland Clinic Akron General Hospital, 1 Akron General Avenue, Akron, OH 44308, United States.
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.
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BibTeX
@article{shah2026predictors,
title = {{Predictors, risk factors and management of intestinal failure in crohn’s disease: A narrative review}},
author = {Dhruvi Shah and Meena Alzamani and Tanisha Sehgal and Vishal Sharma and Manjeet Kumar Goyal},
journal = {Intestinal Failure},
year = {2026},
month = oct,
doi = {10.1016/j.intf.2026.100400},
url = {https://doi.org/10.1016/j.intf.2026.100400},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Predictors, risk factors and management of intestinal failure in crohn’s disease: A narrative review
AU - Dhruvi Shah
AU - Meena Alzamani
AU - Tanisha Sehgal
AU - Vishal Sharma
AU - Manjeet Kumar Goyal
PY - 2026
DA - 2026/10/23
JO - Intestinal Failure
DO - 10.1016/j.intf.2026.100400
UR - https://doi.org/10.1016/j.intf.2026.100400
AB - 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.
SN - 2950-4562
ER -