The Impact of the Shift in Clinical Management From Reactive to Preventative on the Rate of Bowel Resection in Inflammatory Bowel Disease Within a Large Health Care Organization.

This article examines trends in bowel resection and strictureplasty rates among adult patients with inflammatory bowel disease (IBD) within the Kaiser Permanente Southern California (KPSC) health system from 1993 to 2009, using the introduction of biologic therapy—specifically infliximab approved in 1999—as a surrogate marker for the shift from reactive to preventative IBD management. The study found that bowel resection rates were already declining before biologic therapies became widely available and continued to decline afterward, albeit at a slower rate. Demographic analysis revealed that male patients and those identifying as Black or White were more likely to undergo bowel resection. The findings suggest that the transition toward preventative care in IBD management began prior to the biologic era, potentially influenced by multidisciplinary care approaches within the integrated health system, though the exact causes remain unclear.