Skip to Main Content

Crohn's Disease: When Surgery is Required

Crohn's Disease: When Surgery is Required

Dr. Tuckson speaks with colorectal surgeon Dr. Sandra Kavalukas of UofL Health about evaluating patients with Crohn’s disease and when surgery is recommended.
Season 16 Episode 14 Length 26:23 Premiere: 1/24/21

Louisville Surgeon Discusses Treatment Options for Crohn's Disease

Here are key takeaways from an episode of Kentucky Health focusing on Crohn’s disease. Dr. Sandra Kavalukas, a colorectal surgeon at UofL Health, visited to discuss evaluating patients with Crohn’s disease and surgical options for treating it.

Symptoms and Risk Factors for a Painful Intestinal Disease

Patients suffering from Crohn’s disease, an autoimmune inflammatory intestinal disease, have benefited from the development of medications in recent decades to help them avoid surgery. Still, for some patients, surgery is the only effective form of treatment.

Kavalukas says that Crohn’s disease is a “very complex interaction between your immune system and the lining of the intestine and how it interacts with your environment and maybe how it interacts with the bacteria in your colon.” She presents a chart showing the most common areas of the intestine where Crohn’s disease occurs, including the terminal ileum, where the small intestine and colon (large intestine) meet.

“Crohn’s disease by nature has what we say are ‘skip areas,’ so it can kind of be all over the place,” she says. “It can be anywhere from the mouth to the very bottom of the rectum, it can be in the entire tract, it can only be in certain spots, and that’s part of what makes a diagnosis so challenging, is that we can have abdominal pain anywhere.”

A visual hallmark of Crohn’s disease is swelling of the mucosa, the membrane lining the intestinal walls, Kavalukas says. That inflammation makes the intestine unable to absorb water and properly digest food, leading to symptoms such as diarrhea, bloody stool, and bowel obstructions.

Kavalukas says that Crohn’s disease affects about 3 percent of the population and can initially be difficult to diagnose because some of its symptoms – diarrhea and cramping, for example – can also be caused by other diseases such as gastroenteritis or ulcerative colitis. Still, if a patient has ongoing symptoms, especially bloody diarrhea, he or she should get evaluated for Crohn’s disease.

“Crohn’s disease has historically been in mostly industrialized countries,” Kavalukas says. “Within the United States, the northeast has a much higher prevalence than in the south. However, Kentucky, for some reason we’re not clear on yet, has a much higher prevalence compared to other places. Part of my research is trying to figure out if there’s different areas in Kentucky that may put people in contact with well water or certain other things that they’re ingesting in their environment that are predisposing them to Crohn’s disease.”

Kavalukas says that there is a genetic component to getting Crohn’s disease but there are also many other factors that can create a higher risk. Behaviors as smoking, eating raw meat, and using non-steroidal anti-inflammatory drugs (NSAIDs) play a role. “Smokers by far and away have a much higher prevalence of worsened Crohn’s symptoms,” she says.

If a person develops symptoms associated with Crohn’s disease, Kavalukas recommends consulting with a primary care doctor and then a gastroenterologist, who will order a colonoscopy and possibly a CT scan of the abdominal region.

Surgical Options When Medication Does Not Work

“I think that the data before 1990 indicated that approximately 45 to 50 percent of patients diagnosed with Crohn’s disease would end up having surgery in the first five years of their diagnosis,” Kavalukas says. Back then, patients may have been prescribed steroids for a period of time to suppress the autoimmune response, but Kavalukas says eventually the long-term negative effects of using steroids meant that gastroenterologists would recommend surgery.

Starting in the late 1990s, Kavalukas says that new biologic drugs have continuously been developed and approved to treat Crohn’s disease, such as the group of monoclonal antibody drugs targeting autoimmune disorders. Now, she says that about 35 percent of patients with Crohn’s disease are recommended for surgery within the first five years of their diagnosis. In particular, patients who have ileocolic disease are often advised to consider surgery early on in their diagnosis since recurrence rates are low and it’s less expensive than medication.

Kavalukas says surgery can be required for patients due to both emergent and long-term reasons. “A lot of times if they’re getting really bad flares that are not responsive to steroid medications or if they get terribly bloody diarrhea and fevers and chills and even sepsis, in what we call toxic megacolon, that’s something where you’ll be an inpatient and be admitted to the hospital, and it’s a definite emergency,” she says.

Most patients, however, turn to surgery after their condition fails to improve over time, Kavalukas explains. They may have repeated obstructions due to the constant narrowing of the intestinal wall, and some can also develop fistulas. A fistula is new tissue formed abnormally connecting organs (such as the large intestine to the small intestine or to the skin) and causing pain, infection, and other complications.

“In the colon, anytime you have a low level of chronic inflammation that can cause strictures, you also worry that chronic inflammation can cause cancer,” Kavalukas adds. “So both ulcerative colitis and Crohn’s patients are at a higher risk of getting colon cancer because of their inflammation.”

During surgery, Kavalukas says that her goal is to do as limited a resection as possible of the organ she’s operating on, keeping in mind the possibility that future procedures may be required. She says that there are new surgical techniques that she can apply if appropriate that help mitigate the odds of recurrence. She also tries to limit resection in order to prevent what is called short gut syndrome. Kavalukas says that while most people have 300 to 600 centimeters of small intestine, if surgery lowers that to around 200 centimeters the patient will have trouble absorbing the required amount of nutrients during the digestive process.

Once the surgery is completed, patients may return to taking medication for Crohn’s disease depending on whether the disease returns aggressively or not and also on their past tolerance of medication, Kavalukas says. Complications include a higher risk for infection and blood clots. “There’s a lot of factors that come into play, but almost routinely at six months and one year, we do recommend getting an endoscopy because, believe it or not, the symptoms of Crohn’s disease don’t always correlate with the activity in the intestine,” she explains.

Patients who have Crohn’s disease affecting the anus may form fistulas in that area, and are more difficult to treat through surgery, Kavalukas says. “It’s challenging from a provider standpoint because that’s why we went into medicine – to help these patients,” she notes. “At the same time, helping these patients is not operating on them, because as of right now, there is something about the disease activity that will not heal.” She says that around 20 to 25 percent of patients with Crohn’s disease will have perianal disease. As a last resort if the disease progression becomes too intense, the anus and rectum may have to be removed and the patient will have to wear a colostomy bag.

“I always tell our trainees and residents that the main reason I like taking care of Crohn’s disease is that it’s one of the few times it’s really a conversation between you and the patient,” Kavalukas says. “I ask them, ‘Where are you at? Are you getting to the end of your rope?’ Most of Crohn’s patients are young, healthy people, and they need to get back to work and they just want to feel good. And so that’s the kind of time where it’s exciting to go to the operating room, because you feel like you really can make them better.”

Brought to you by:

Kentucky Headlines logo in white against a blue and red background and a "Check Schedule" button.Kentucky Headlines logo in white against a blue and red background and a "Check Schedule" button.

Program Details

Kentucky Health

About Kentucky Health

Learn how to improve your health through education and increased awareness. Dr. Wayne Tuckson, a colorectal surgeon in Louisville, hosts.

TV Schedules

Jump to Recent Airdates

Upcoming

Oral Cancer and HPV: The Surprising Connection

Premiered On: 11/21/2021

Kentucky has the highest rate of cancers caused by the Human papillomavirus (HPV) in the U.S. Dr. Tuckson discusses the prevention, diagnosis and treatment of HPV-related oral and throat cancer with Dr. Pam Stein VanArsdall, DMD, professor and division chief of Public Health Dentistry at the University of Kentucky.

  • Sunday May 22, 2022 12:30 am ET on KETKY
  • Saturday May 21, 2022 11:30 pm CT on KETKY
  • Sunday May 22, 2022 7:00 am ET on KET2
  • Sunday May 22, 2022 6:00 am CT on KET2
  • Sunday May 22, 2022 9:00 am ET on KETKY
  • Sunday May 22, 2022 8:00 am CT on KETKY

Lung Health: Breathing Does a Body Good

Dr. Neal Moser, a pulmonologist and president of the Kentucky Medical Association, discusses the most common threats to our lungs and the best ways to protect them.

  • Sunday May 22, 2022 12:30 pm ET on KET
  • Sunday May 22, 2022 11:30 am CT on KET
  • Sunday May 22, 2022 5:30 pm ET on KETKY
  • Sunday May 22, 2022 4:30 pm CT on KETKY
  • Monday May 23, 2022 2:00 pm ET on KET2
  • Monday May 23, 2022 1:00 pm CT on KET2
  • Friday May 27, 2022 1:30 pm ET on KETKY
  • Friday May 27, 2022 12:30 pm CT on KETKY
  • Friday May 27, 2022 6:00 pm ET on KET
  • Friday May 27, 2022 5:00 pm CT on KET
  • Friday May 27, 2022 11:30 pm ET on KET
  • Friday May 27, 2022 10:30 pm CT on KET
  • Sunday May 29, 2022 12:30 am ET on KETKY
  • Saturday May 28, 2022 11:30 pm CT on KETKY
  • Sunday May 29, 2022 7:00 am ET on KET2
  • Sunday May 29, 2022 6:00 am CT on KET2
  • Sunday May 29, 2022 9:00 am ET on KETKY
  • Sunday May 29, 2022 8:00 am CT on KETKY

Otitis Media: Impact on Hearing and Learning

Dr. Swapna Kartha Chandran, an otolaryngologist with UofL Health, talks about the impact of recurrent otitis media (ear infection) on learning and hearing in young children.

  • Sunday May 29, 2022 12:30 pm ET on KET
  • Sunday May 29, 2022 11:30 am CT on KET
  • Sunday May 29, 2022 5:30 pm ET on KETKY
  • Sunday May 29, 2022 4:30 pm CT on KETKY
  • Monday May 30, 2022 2:00 pm ET on KET2
  • Monday May 30, 2022 1:00 pm CT on KET2
  • Friday June 3, 2022 1:30 pm ET on KETKY
  • Friday June 3, 2022 12:30 pm CT on KETKY
  • Sunday June 5, 2022 12:30 am ET on KETKY
  • Saturday June 4, 2022 11:30 pm CT on KETKY
  • Sunday June 5, 2022 7:00 am ET on KET2
  • Sunday June 5, 2022 6:00 am CT on KET2
  • Sunday June 5, 2022 9:00 am ET on KETKY
  • Sunday June 5, 2022 8:00 am CT on KETKY

ICU Care: The Care That You Hope You Don't Need

The intensive care unit (ICU) is where a hospital cares for its sickest patients. Dr. Tuckson talks with Dr. Kandis Adkins, critical care specialist at UofL Health, about how ICUs save lives and return patients to health.

  • Sunday June 5, 2022 12:30 pm ET on KET
  • Sunday June 5, 2022 11:30 am CT on KET
  • Sunday June 5, 2022 5:30 pm ET on KETKY
  • Sunday June 5, 2022 4:30 pm CT on KETKY
  • Monday June 6, 2022 2:00 pm ET on KET2
  • Monday June 6, 2022 1:00 pm CT on KET2
  • Friday June 10, 2022 1:30 pm ET on KETKY
  • Friday June 10, 2022 12:30 pm CT on KETKY
  • Sunday June 12, 2022 12:30 am ET on KETKY
  • Saturday June 11, 2022 11:30 pm CT on KETKY
  • Sunday June 12, 2022 7:00 am ET on KET2
  • Sunday June 12, 2022 6:00 am CT on KET2
  • Sunday June 12, 2022 9:00 am ET on KETKY
  • Sunday June 12, 2022 8:00 am CT on KETKY

Orthopedic Oncology: Bones Get Cancer Too

Most tumors found in the bone are benign, but not all. Dr. Tuckson talks with Dr. Shawn Price an orthopedic surgeon with the Fortis Orthopaedic and Sarcoma Group about primary bone cancer and its treatment.

  • Sunday June 12, 2022 12:30 pm ET on KET
  • Sunday June 12, 2022 11:30 am CT on KET
  • Sunday June 12, 2022 5:30 pm ET on KETKY
  • Sunday June 12, 2022 4:30 pm CT on KETKY
  • Monday June 13, 2022 2:00 pm ET on KET2
  • Monday June 13, 2022 1:00 pm CT on KET2
  • Friday June 17, 2022 1:30 pm ET on KETKY
  • Friday June 17, 2022 12:30 pm CT on KETKY
  • Sunday June 19, 2022 12:30 am ET on KETKY
  • Saturday June 18, 2022 11:30 pm CT on KETKY
  • Sunday June 19, 2022 7:00 am ET on KET2
  • Sunday June 19, 2022 6:00 am CT on KET2
  • Sunday June 19, 2022 9:00 am ET on KETKY
  • Sunday June 19, 2022 8:00 am CT on KETKY

LGBTQ Healthcare: Removing the Stigma, Improving the Outcome

Gay, lesbian, bi-sexual, transgender and queer patients often delay health care for fear of bias or judgment. Dr. Tuckson interviews Dr. Karen Williamson Krigger, family medicine physician at UofL Health, about how the medical community can better address the needs of LGBTQ patients.

  • Sunday June 19, 2022 12:30 pm ET on KET
  • Sunday June 19, 2022 11:30 am CT on KET
  • Sunday June 19, 2022 5:30 pm ET on KETKY
  • Sunday June 19, 2022 4:30 pm CT on KETKY
  • Monday June 20, 2022 2:00 pm ET on KET2
  • Monday June 20, 2022 1:00 pm CT on KET2
Jump to Upcoming Airdates

Recent

Oral Cancer and HPV: The Surprising Connection - S17 E8

  • Friday May 20, 2022 11:30 pm ET on KET
  • Friday May 20, 2022 10:30 pm CT on KET
  • Friday May 20, 2022 6:00 pm ET on KET
  • Friday May 20, 2022 5:00 pm CT on KET
  • Friday May 20, 2022 1:30 pm ET on KETKY
  • Friday May 20, 2022 12:30 pm CT on KETKY
  • Monday May 16, 2022 2:00 pm ET on KET2
  • Monday May 16, 2022 1:00 pm CT on KET2
  • Sunday May 15, 2022 5:30 pm ET on KETKY
  • Sunday May 15, 2022 4:30 pm CT on KETKY
  • Sunday May 15, 2022 12:30 pm ET on KET
  • Sunday May 15, 2022 11:30 am CT on KET

Medical Information: Discerning the Wheat from the Chaff - S17 E7

  • Sunday May 15, 2022 9:00 am ET on KETKY
  • Sunday May 15, 2022 8:00 am CT on KETKY
  • Sunday May 15, 2022 7:00 am ET on KET2
  • Sunday May 15, 2022 6:00 am CT on KET2
  • Sunday May 15, 2022 12:30 am ET on KETKY
  • Saturday May 14, 2022 11:30 pm CT on KETKY
  • Friday May 13, 2022 6:00 pm ET on KET
  • Friday May 13, 2022 5:00 pm CT on KET
  • Friday May 13, 2022 1:30 pm ET on KETKY
  • Friday May 13, 2022 12:30 pm CT on KETKY
  • Monday May 9, 2022 2:00 pm ET on KET2
  • Monday May 9, 2022 1:00 pm CT on KET2
  • Sunday May 8, 2022 5:30 pm ET on KETKY
  • Sunday May 8, 2022 4:30 pm CT on KETKY
  • Sunday May 8, 2022 12:30 pm ET on KET
  • Sunday May 8, 2022 11:30 am CT on KET

Glaucoma and Cataracts: What's Clear and Are They Inevitable? - S17 E6

  • Sunday May 8, 2022 9:00 am ET on KETKY
  • Sunday May 8, 2022 8:00 am CT on KETKY
  • Sunday May 8, 2022 7:00 am ET on KET2
  • Sunday May 8, 2022 6:00 am CT on KET2
  • Sunday May 8, 2022 12:30 am ET on KETKY
  • Saturday May 7, 2022 11:30 pm CT on KETKY
  • Friday May 6, 2022 11:30 pm ET on KET
  • Friday May 6, 2022 10:30 pm CT on KET
  • Friday May 6, 2022 6:00 pm ET on KET
  • Friday May 6, 2022 5:00 pm CT on KET
  • Friday May 6, 2022 1:30 pm ET on KETKY
  • Friday May 6, 2022 12:30 pm CT on KETKY
  • Monday May 2, 2022 2:00 pm ET on KET2
  • Monday May 2, 2022 1:00 pm CT on KET2
  • Sunday May 1, 2022 5:30 pm ET on KETKY
  • Sunday May 1, 2022 4:30 pm CT on KETKY
  • Sunday May 1, 2022 12:30 pm ET on KET
  • Sunday May 1, 2022 11:30 am CT on KET

Migraines and Headaches: They Are Serious and Can Be Incapacitating - S17 E25

  • Sunday May 1, 2022 9:00 am ET on KETKY
  • Sunday May 1, 2022 8:00 am CT on KETKY
  • Sunday May 1, 2022 7:00 am ET on KET2
  • Sunday May 1, 2022 6:00 am CT on KET2
  • Sunday May 1, 2022 12:30 am ET on KETKY
  • Saturday April 30, 2022 11:30 pm CT on KETKY
  • Friday April 29, 2022 11:30 pm ET on KET
  • Friday April 29, 2022 10:30 pm CT on KET
  • Friday April 29, 2022 6:00 pm ET on KET
  • Friday April 29, 2022 5:00 pm CT on KET
  • Friday April 29, 2022 1:30 pm ET on KETKY
  • Friday April 29, 2022 12:30 pm CT on KETKY
  • Monday April 25, 2022 2:00 pm ET on KET2
  • Monday April 25, 2022 1:00 pm CT on KET2
  • Sunday April 24, 2022 5:30 pm ET on KETKY
  • Sunday April 24, 2022 4:30 pm CT on KETKY
  • Sunday April 24, 2022 12:30 pm ET on KET
  • Sunday April 24, 2022 11:30 am CT on KET

Ankle Replacement: It's Not Just for Hips, Knees and Shoulders - S17 E24

  • Sunday April 24, 2022 9:00 am ET on KETKY
  • Sunday April 24, 2022 8:00 am CT on KETKY
  • Sunday April 24, 2022 7:00 am ET on KET2
  • Sunday April 24, 2022 6:00 am CT on KET2
  • Sunday April 24, 2022 12:30 am ET on KETKY
  • Saturday April 23, 2022 11:30 pm CT on KETKY
  • Friday April 22, 2022 6:00 pm ET on KET
  • Friday April 22, 2022 5:00 pm CT on KET
  • Friday April 22, 2022 1:30 pm ET on KETKY
  • Friday April 22, 2022 12:30 pm CT on KETKY
Top

Season 16 Episodes

Emergency Departments in Rural Kentucky

S16 E27 Length 27:19 Premiere Date 5/2/21

Public Health: Where Do We Go From Here?

S16 E26 Length 27:50 Premiere Date 4/25/21

Telemedicine: Better Than Dr. Google

S16 E25 Length 27:13 Premiere Date 4/17/21

Hospice and Palliative Care: The Bridge Over Troubled Waters

S16 E23 Length 26:56 Premiere Date 4/11/21

The Impact of Racism on Health Outcomes

S16 E22 Length 27:43 Premiere Date 4/4/21

A Tribute to Health Care Providers

S16 E21 Length 28:46 Premiere Date 3/28/21

Sepsis: The Serious Side of Infections

S16 E20 Length 28:04 Premiere Date 3/21/21

The Future of Long-Term Care in Kentucky

S16 E19 Length 27:14 Premiere Date 3/14/21

Addiction and Recovery in the Time of COVID-19

S16 E18 Length 27:43 Premiere Date 2/21/21

Infections of the Brain and Nervous System

S16 E17 Length 27:00 Premiere Date 2/14/21

Rural Healthcare: Who Pays and Who Benefits

S16 E16 Length 27:39 Premiere Date 2/7/21

Pancreatic Cancer: Uncommon But Deadly

S16 E15 Length 26:53 Premiere Date 1/31/21

Crohn's Disease: When Surgery is Required

S16 E14 Length 26:23 Premiere Date 1/24/21

Visualizing a Smoke-Free Kentucky

S16 E13 Length 27:33 Premiere Date 1/17/21

COVID-19 Vaccine: Ready for Prime Time

S16 E12 Length 26:56 Premiere Date 1/10/21

Contact Tracing: Knowing Keeps Us All Safe

S16 E11 Length 27:37 Premiere Date 1/3/21

Reducing the Burden of Diabetes in Kentucky

S16 E10 Length 27:02 Premiere Date 12/20/20

The Impact of Race-Based Trauma

S16 E9 Length 28:17 Premiere Date 12/13/20

Planning a Healthy and Nutritional Diet

S16 E8 Length 27:02 Premiere Date 11/22/20

The Immune System: Not Just Fighting Infections

S16 E7 Length 26:52 Premiere Date 11/15/20

New Approaches to Shoulder Replacement

S16 E6 Length 27:02 Premiere Date 11/8/20

Oral Healthcare: Our Teeth Should Last a Lifetime

S16 E5 Length 27:00 Premiere Date 11/1/20

Gun Violence: It is a Public Health Issue

S16 E4 Length 26:52 Premiere Date 10/25/20

Strengthening the Immune System Through Diet

S16 E3 Length 26:51 Premiere Date 10/18/20

Interventional Cardiology

S16 E2 Length 26:40 Premiere Date 10/11/20

The Importance of Preventive Cardiology

S16 E1 Length 26:18 Premiere Date 10/4/20

Explore KET