Perioperative optimization of Crohn's disease.

Crohn's disease (CD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. With the increased availability of modalities in the last two decades, the treatment of CD has advanced remarkably. Although medical treatment is the mainstay of therapy, most patients require surgery during the course of their illness, especially those who experience complications. Nutritional optimization and ERAS implementation are crucial for patients with CD who require surgical intervention to reduce postoperative complications. The increased surgical risk was found to be associated with the use of corticosteroids, but the association of surgical risk with immunomodulators, biologic therapy, such as anti-TNF mediations, anti-integrin medications, and anti-IL 12/23 was low in certainty. Decisions about preoperative medication must be made on an individual case-dependent basis. Preoperative imaging studies can assist in the planning of appropriate surgical strategies and approaches. However, patients must be informed of any alterations to their treatment. In summary, the management of perioperative medications and surgery-related decision-making should be individualized and patient-centered based on a multidisciplinary approach.

The standardizing texture of thickened barium stimuli in the videofluoroscopic swallowing study at a medical center in Taiwan.

This study aimed to establish more practical standardized barium stimuli formulas for the videofluoroscopic swallowing study (VFSS) for clinical use. For clinical practice, we established the formula for preparing barium stimuli to comply with different International Dysphagia Diet Standardization Initiative (IDDSI) levels. To comply with the definition of IDDSI levels 0-4, the gum-based thickener concentration of thickened barium was 0, 0.3, 0.6, 1.0, and 2.0 g/100 mL, respectively. The formulas established in this study may replace traditional barium stimuli for dysphagia assessment in clinical settings.