Anorectal Crohn's disease

Wolff, Bruce G.; Culp, Clyde E.; Beart, Robert W.; Ilstrup, Duane M.; Roger, M; Ready, Lauren V.

doi:10.1007/bf02560279

Cited by 134 publications

(22 citation statements)

References 12 publications

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“…It has been also reported that 20% of patients receiving colectomy will require proctectomy within 5 years [19]. These observations justify the disturbingly high rate of proctectomy still observed, ranging between 10 and 18% [10, 49]. Recently, IFX proved to be effective in CD patients with failed ileorectal anastomosis candidates to proctectomy, preserving the rectum in 10/12 patients (83.3%) [78].…”

Section: Treatmentmentioning

confidence: 99%

“…Genetic and epigenetic factors play a pivotal role in CD, as the risk of developing CD and its related complications is higher in relatives of CD patients than in general population [5, 8]. Genetic susceptibility is suggested by the frequent association between perianal CD and colorectal as well as upper gastrointestinal disease involvement [9, 10] so that CD is a different entity from penetrating abdominal CD [9] and is also associated with worse prognosis in the long term [11]. Also, as active, persisting disease leads to fibrosis in CD [5], a hypoxia-mediated mechanism could also play a role [12].…”

Section: Introductionmentioning

confidence: 99%

“…Repeated maneuvers and too aggressive approaches justify the rate of incontinence still observed with conventional, cutting techniques in these patients, even reaching 50% for intersphincteric fistulae [15]. It should be noted that faecal diversion and proctectomy still play a relevant role in perianal CD [10, 16–19], further suggesting that the ideal management of such patients is yet to be achieved.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview

Pellino

Selvaggi

2014

The Scientific World Journal

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Background. Perianal Crohn's disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons.

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Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview

Pellino

Selvaggi

2014

The Scientific World Journal

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“…Despite these, most patients have undesirable results, which can lead to proctectomy in 10%–18% of cases. [1112131415]…”

Section: Introductionmentioning

confidence: 99%

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

et al. 2017

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Medical treatment for fistulizing Crohn's disease (FCD) is changing rapidly over the time by the introduction of novel therapeutic medicines, while no global consensus is available. This study aims to accomplish a systematic review and meta-analysis on the efficacy of tumor necrosis factor-alpha antibodies (anti-TNF-α antibodies) versus placebo in FCD. A systematic review of published literature was carried out till December 2016, and a meta-analysis of identified studies was done. Data have been explored from PubMed, Scopus, Cochrane Library Database, and Web of Science. Predefined exclusion criteria for included studies in meta-analysis are based on search methodology and are as follows: Randomized clinical trial about Crohn's disease (CD) patients without fistula, pediatrics CD, randomized clinical trials about pregnant women with FCD, nonhuman studies, randomized clinical trials with surgical therapies interventions, conference abstracts, case reports, and language other than English studies. All randomized placebo-controlled trials were included. To assess risk of bias, Jadad score was applied to evaluate trials' methodological quality. Relative risk (RR) and 95% confidence intervals were computed using Mantel-Haenszel and/or Rothman-Boice (for fixed effects) or Der Simonian-Laird (for random effects) techniques. Nine studies attained defined inclusion criteria. The meta-analysis results showed that anti-TNF-α antibodies are remarkably more effective in comparison to placebo for fistula closure maintenance (RR = 2.36; 95% confidence interval: 1.58–3.55; P < 0.0001) in patients with FCD, whereas anti-TNF-α antibodies were not superior to placebo neither in fistula improvement nor in fistula closure. We concluded that adalimumab and certolizumab pegol are both effective in fistula closure maintenance in adult patients with FCD.

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“…Seventy-two percent of patients with colorectal CD will undergo a surgical treatment [3]; proctectomy with permanent stoma will be the choice in about 20% of patients with perianal disease [4,5]. …”

Section: Introductionmentioning

confidence: 99%

Infliximab in Drug-Naïve Patients with Failed Ileorectal Anastomosis for Crohn’s Disease: A New Chance for Sparing the Rectum?

Sciaudone

Pellino²,

Riegler³

et al. 2011

Eur Surg Res

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The aim of this intervention study is to determine whether long-term infliximab therapy can decrease the proctectomy rate in patients with failed total colectomy and ileorectal anastomosis (IRA) for Crohn’s disease (CD). Twelve patients (5 females) – with a median age of 36.6 years (range 18–56 years), previously treated with IRA (5 in our institution and 7 referred) for colorectal and perianal CD (median Crohn’s Disease Activity Index 334.5, range 220–426), with rectal disease recurrence requiring proctectomy, no responders to conventional therapy but infliximab-naïve – were treated with infliximab infusions (Remicade™ 5 mg/kg at 0, 2, 6 weeks and then every 8 weeks) to avoid proctectomy. The main outcome measures consisted of IRA preservation and bowel function at study end. Mortality and major adverse reactions have not been observed. At the time of the median follow-up (57.4 months, range 36–92), the rectum was preserved in 10 patients (83.3%). One patient underwent proctectomy 6 weeks after the beginning of the treatment for unresponsiveness to drugs and another after 26 weeks for rectal stenosis. Anorectal function (maximum tolerated volume: 239 ± 43 vs. 294 ± 36 ml) and quality of life (Inflammatory Bowel Disease Questionnaire score 89.2 ± 20.6 vs. 173.8 ± 31.9) improved, and the Wexner Continence score (4.4 ± 2.4 vs. 1.7 ± 1.0) and daily defecations (5.2 ± 1.03 vs. 2.7 ± 1.05) decreased in 10 patients. Our results, although preliminary, are encouraging and seem to justify a less aggressive approach in patients with rectal and perianal recurrence after IRA for CD.

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Anorectal Crohn's disease

Cited by 134 publications

References 12 publications

Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview

Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

Infliximab in Drug-Naïve Patients with Failed Ileorectal Anastomosis for Crohn’s Disease: A New Chance for Sparing the Rectum?

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