Combined Seton Placement, Infliximab Infusion, and Maintenance Immunosuppressives Improve Healing Rate in Fistulizing Anorectal Crohn's Disease

Topstad, Dawnelle; Panaccione, Remo; Heine, J.; Johnson, Douglas; MacLean, Anthony R.; Buie, W. Donald

doi:10.1007/s10350-004-6611-4

Cited by 241 publications

(155 citation statements)

References 22 publications

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“…Female gender, complex fistula formation, active intestinal and rectal diseases were reported as factors independently associated with failure of combined treatment [16,17]. Any factor, which significantly related to complete response, could not be found in the study.…”

Section: Discussioncontrasting

confidence: 41%

“…In our opinion, surgeon would be aware of complex or multiple fistulas owing to preoperative MRI, and it indirectly increases the success of the treatment. [16] 29…”

Section: Discussionmentioning

confidence: 99%

“…Studies, which investigated the results of combined seton and anti-TNF treatment for PFCD, reported a great range of complete response rate between 18-75% (Table IV) [11,12,[15][16][17][18][19][20][21][22][23][24]. Table IV was meticulously prepared only for PFCD.…”

Section: Discussionmentioning

confidence: 99%

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Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

Yardimci¹,

Kara²,

Attaallah³

et al. 2016

MMJ

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The aim of this study was to evaluate the efficacy of combined treatment with anti-tumor necrosis factor (TNF) agents, and setons for perianal fistulas in Crohn's disease.Patients and Methods: Study included 27 consecutive patients with perianal fistulizing Crohn's disease, requiring seton drainage and anti-TNF therapy in our center from January 2013 to November 2014. All patients underwent a standardized pelvic magnetic resonance imaging (MRI) examination. Patient characteristics, follow up time, findings of pelvic MRI, colonoscopy and examination under anesthesia findings were recorded. Response to treatment was evaluated at the end of the follow up. Results:The median follow-up after treatment was 17 months (6-32). The fistula was complex in 24 (89%) of the 27 patients. Colonoscopy revealed ileitis in 16 (59.3%) patients and active proctitis in 9 (33.3%) patients. Perianal abscess was observed in 12 (44.4%) patients. Complete response was obtained in 17 (63%) patients. Only 3 (11.1%) patients experienced recurrence abscess during the study period. We could not find any factor, which were associated with complete response. Conclusion:Complete response was achieved in 63% of the patients, with perianal fistula formation associated with Crohn's disease, with combined seton drainage and anti-TNF therapy.

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Section: Discussioncontrasting

confidence: 41%

“…In our opinion, surgeon would be aware of complex or multiple fistulas owing to preoperative MRI, and it indirectly increases the success of the treatment. [16] 29…”

Section: Discussionmentioning

confidence: 99%

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Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

Yardimci¹,

Kara²,

Attaallah³

et al. 2016

MMJ

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“…In contrast, a complex fistula is located high (high transsphincteric, extrasphincteric or suprasphincteric), may be associated with pain, can potentially involve multiple external openings, and may be associated with rectovaginal fistula and/or anorectal stricture [6]. This is a clinically important differentiation, because several studies have shown better outcomes for patients with simple fistula tracts [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, ineffective or inappropriate treatment of perianal fistula may lead to recurrence of the fistula or can result in the fistula progressing from simple to complex form [17]. Complex fistulas are more difficult to treat, have decreased healing rates, and are associated with less successful outcomes [7][8][9][10]. For these reasons, it would be very important to have predictors of the response of perianal fistulas to antibiotics.…”

Section: Introductionmentioning

confidence: 99%

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

et al. 2010

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Background CARD15 mutations alter bowel immunity and increase susceptibility to Crohn 0 s disease (CD). However, the relation between these mutations and Crohn 0 s perianal fistulas has not been fully clarified. Aims To assess whether CARD15 mutations are associated with risk of developing Crohn's perianal fistulas and whether these mutations are predictors of the response of perianal fistulas to antibiotics. Methods CARD15 mutations were investigated in 203 consecutive CD patients. Presence/absence of history of perianal fistula was recorded. Patients with history of perianal fistula were divided into two groups (with/without CARD15 mutations), and response to antibiotics was evaluated in both groups. Results Of the 203 patients, 60 (29.6%) showed at least one CARD15 mutation and 55 (27.1%) had history of perianal fistula. History of perianal fistula was identified in 13 (21.7%) patients with mutations and in 42 (29.4%) patients without mutations (P = 0.260). Mean age at diagnosis of first perianal fistula was similar in patients with/without CARD15 mutations (28.7 ± 9.8 versus 29.7 ± 10.1 years, P = 0.758). Average time between disease onset and diagnosis of first perianal fistula was also similar in the two groups (4.6 ± 5.1 versus 5.0 ± 5.9 years, P = 0.816). Response of perianal fistulas to antibiotics (metronidazole alone or combined with ciprofloxacin) was significantly higher in patients without CARD15 mutations (7.7% versus 40.5%, P = 0.041). Conclusions In CD, CARD15 mutations are not associated with risk of developing perianal fistulas or with time of their outbreak. Nevertheless, patients with perianal fistulas and CARD15 mutations showed worse response to antibiotics.

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Surgical Considerations for the Patient with Crohn's Disease/Perianal Crohn's Disease

McLeod

2010

Inflammatory Bowel Disease

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Combined Seton Placement, Infliximab Infusion, and Maintenance Immunosuppressives Improve Healing Rate in Fistulizing Anorectal Crohn's Disease

Cited by 241 publications

References 22 publications

Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

Surgical Considerations for the Patient with Crohn's Disease/Perianal Crohn's Disease

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