Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn’s Disease: The Toronto Consensus

Steinhart, A. Hillary; Panaccione, Remo; Targownik, Laura E.; Bressler, Brian; Khanna, Reena; Marshall, John K.; Afif, Waqqas; Bernstein, Çharles N.; Bitton, Alain; Borgaonkar, Mark; Chauhan, Usha; Halloran, Brendan P.; Jones, Jennifer; Kennedy, Erin; Leontiadis, Grigorios I; Loftus, Edward V.; Meddings, Jonathan B.; Martin, Paul; Murthy, Sanjay K.; Plamondon, Sophie; Rosenfeld, Greg; Schwartz, David A.; Seow, Cynthia H.; Cn, Williams

doi:10.1093/ibd/izy247

Cited by 85 publications

(65 citation statements)

References 81 publications

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“…Its etiology and pathogenesis are not yet clear [1,2]. Perianal fistulas, especially complex anal fistula, are recognized complications of Crohn's disease (CD), which can lead to substantial morbidity and reduce quality of life [3]. Complex anal fistula, especially Crohn's fistula-in-ano, is a refractory disease in colorectal and anal surgery [4].…”

Section: Introductionmentioning

confidence: 99%

Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial

Zhou

Zhang

et al. 2020

Stem Cell Res Ther

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Background: Crohn's fistula-in-ano is a refractory disease in colorectal and anal surgery. Although autologous adiposederived stem cell (ADSC) has been used in the treatment of Crohn's fistula-in-ano because of its convenience, nonincision of normal tissue, good tolerance, repeatability, quick recovery, less pain, less damage to anal function, and high quality of life during the perioperative period, there are no reports of its use in China. This is the first clinical trial in China on the treatment of Crohn's fistula-in-ano with ADSC to evaluate its efficacy and safety. Methods: A total of 22 patients with Crohn's fistula-in-ano were enrolled in this study from January 2018 to October 2018 in the

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Section: Introductionmentioning

confidence: 99%

Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial

Zhou

Zhang

et al. 2020

Stem Cell Res Ther

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“…15,37,38 Perianal fistulizing complications are difficult to treat; they often require invasive surgical procedures but still commonly reoccur. 5,39,40 Despite optimal medical and/or surgical therapy, there remains a substantial risk of requiring a permanent ostomy. Therefore, evidence-based strategies for preventing PFC development among patients with CD are greatly needed.…”

Section: Discussionmentioning

confidence: 99%

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

et al. 2020

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IMPORTANCE Perianal fistulizing complications (PFCs) develop in 15% to 30% of patients with Crohn disease (CD), are difficult to treat, worsen quality of life, increase cost of care, and commonly recur. Evidence-based strategies to prevent PFCs are lacking. OBJECTIVES To investigate the effectiveness of medical therapy for reducing risk of PFCs among young people with CD and to test the hypothesis that steroid-sparing therapy (SST) use would be associated with reduced risk of PFC development.

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“…[17, 22, 23, 25] Importantly, no study to date has addressed prevention of perianal fistulas. [47] We believe that our claims-based approach establishes a validated basis for identifying fistulizing Crohn’s cases, serving as the basis for future quality of care and outcomes studies.…”

Section: Discussionmentioning

confidence: 99%

Identifying perianal fistula complications in pediatric patients with Crohn’s disease using administrative claims

et al. 2019

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Background Although perianal fistulas occur commonly in pediatric Crohn’s disease (CD), evaluations of health services have been limited since no validated claims-based methods exist for identifying cases. Objective To develop and validate accurate case definitions for perianal fistulas among pediatric patients with CD from administrative claims. Methods Retrospective cohort study in which we developed and tested candidate case definitions for perianal fistula. Patients (age 5–21 years between 2005–2012) with CD enrolled in Michigan Medicaid with healthcare at University of Michigan were identified via claims. Medical records were obtained from all identified patients, whose entire records were abstracted. Medical record evidence for perianal fistula was considered the “gold standard” against which candidate case definitions were compared. The reference case definition of perianal fistula (ICD9 565.1) and candidate case definitions were evaluated. Results Of 843 patients identified via claims, 274 (33%) met CD criteria for inclusion. The true perianal fistula rate among CD patients was 18% (n = 49). The top-performing candidate case definition identified 15% (n = 42), had sensitivity of 77.6%, specificity of 98.2%, positive predictive value (PPV) 90.5%, negative predictive value (NPV) 95.3%, and area under receiver operator characteristic curve (ROC) of 0.88. In contrast, the reference case definition identified 9% (n = 26), sensitivity 51.0%, specificity 99.6%, PPV 96.2%, NPV 90.3%, and had an area under ROC of 0.75. Conclusions We demonstrated that it is feasible to use administrative claims data to accurately identify pediatric patients with perianal fistula complications. Claims-based case definitions were found to be highly accurate through medical record review, providing a high degree of confidence for future studies where chart review is not feasible. These claims-based methods can be applied to claims data in other settings for the evaluation of health services utilization as well as to assess the comparative effectiveness of prevention and treatment strategies.

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Clinical Practice Guideline for the Medical Management of Perianal Fistulizing Crohn’s Disease: The Toronto Consensus

Abstract: Optimal management of perianal fistulizing CD requires a collaborative effort between gastroenterologists and surgeons and may include the evidence-based use of existing therapies, as well as surgical assessments and interventions when needed.

Cited by 85 publications

References 81 publications

Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial

Autologous adipose-derived stem cells for the treatment of Crohn’s fistula-in-ano: an open-label, controlled trial

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

Identifying perianal fistula complications in pediatric patients with Crohn’s disease using administrative claims

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