Practical insights into stomas in inflammatory bowel disease: what every healthcare provider needs to know.

Abstract

Despite advances in medical and surgical therapy in inflammatory bowel disease (IBD) management, intestinal stomas can be needed in a significant proportion of patients. The impact of stomas in patients' lives is significant, and the topic is still challenging for different specialties involved in IBD care. Indications for intestinal ostomies in IBD can occur in elective (malnutrition, anemia, or previous steroids) or emergency (perforation, abdominal abscess, obstruction) settings. Different types of stomas can be used (loop, end, or double loop ostomies) depending on different clinical scenarios. Ileostomies are more frequently needed in IBD patients than colostomies, which may be associated with higher rates of recurrence in Crohn's disease. Only 16.6% of patients with diverting stomas for perianal Crohn's disease have successful transit restoration, and stomas become permanent. Prevention of complications is based on adequate preoperative demarcation and meticulous surgical technique. IBD stoma-related morbidity can occur in up to 70% of patients, are more common in Crohn's disease, and can be classified into early or late complications. A multidisciplinary approach including gastroenterologists, surgeons, and stoma nurses is essential for IBD patients who will face the challenge of having a stoma during their disease course.