Fistulizing Crohn's disease

Czerwińska

et al. 2021

Life

Perianal fistula in patients with Crohn’s disease is an extremely challenging condition. The disease tends to reoccur, and with current treatment options, a large number of patients are left with active ailment and experience major morbidity. In recent years, hopeful results regarding local use of mesenchymal stem cells (MSCs) in perianal Crohn’s disease have been published. Although to this day there are no clear guidelines determining optimal dosage, injections frequency and culture conditions, their efficiency has proven to be much higher than conventionally used methods. According to studies, they can effectively induce as well as maintain fistula closure. This approach also avoids common side effects related to conventional surgical treatment.

Section: Admire-cdmentioning

confidence: 99%

Current Overview on the Use of Mesenchymal Stem Cells for Perianal Fistula Treatment in Patients with Crohn’s Disease

Czerwińska

et al. 2021

Life

“…There may be other sequelae of CD, including mouth ulcers. In the absence of features definitive for CD, a fistula may occur in the presence of IBD related to primary idiopathic pouchitis or cuffitis [37].…”

Section: Causes Of the Pouch Behaving Badlymentioning

confidence: 99%

The pouch behaving badly: management of morbidity after ileal pouch–anal anastomosis

et al. 2021

Aim Ileal pouch–anal anastomosis (IPAA), or a ‘pouch’, allows restoration of intestinal continuity after proctocolectomy for ulcerative colitis or familial adenomatous polyposis. Most patients have a good long‐term outcome after IPAA, but in a significant proportion the functional outcome and quality of life are unsatisfactory. We term this outcome ‘the pouch behaving badly’. Managing this, especially one is when unfamiliar with the possible underlying pathologies, is a challenge for both patient and clinician. We aim to outline the clinical approach to the pouch behaving badly, highlighting key aspects of investigation and management. Method This is a narrative review of the literature covering the investigation and management of postoperative complications and morbidity after IPAA. Results Management of the pouch behaving badly requires a careful clinical assessment. The patient may present with multiple symptoms and a clear picture of the symptomatology and past history should be constructed before thorough examination and specialist investigation. We divide the pathology that underlies this clinical scenario into surgical, inflammatory, mechanical, functional and dysplastic causes and outline the investigation and management of each one. Conclusion The pouch behaving badly is a challenging problem for both patient and clinician. A detailed clinical assessment with careful specialist investigation is key to diagnosing the underlying pathology. We stress the importance of patient‐centred care – the aim is to improve quality of life.

“…Anal and perianal localizations in CD are frequent and the evolution vary from regression to a prolonged and chronic state. In this latter case the lesions can worsen with large mucocutaneous and muscular involvement that considerably modify the anorectal architecture [3][4][5][6][7]. Moreover, these lesions seem to have an autonomous evolutionary power: a treatment can be perfectly effective on the intestinal location while the anoperineal lesions continue to evolve on their own account.…”

Section: Introductionmentioning

confidence: 99%

“…Antibiotics (metronidazole and ciprofloxacin) only have a temporary effect on symptoms and their prolonged use can induce adverse side effects (peripheral neuropathy, tendon rupture). In the presence of suppuration, the best conventional approach is surgery with drainage of any abscesses, fistulotomy, or placement of a seton [6,7]. In some patients with severe perianal disease, a proctectomy and a diverting stoma may be required.…”

Section: Introductionmentioning

confidence: 99%

“…The increasing incidence and the difficulties of treating some lesions represent real problems for public health and medical management. The fistulizing phenotype of disease is notoriously difficult to treat, especially when located perianally [ 2 , 3 , 4 , 5 , 6 ]. Anal and perianal localizations in CD are frequent and the evolution vary from regression to a prolonged and chronic state.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adipose-Derived Stem Cells in the Treatment of Perianal Fistulas in Crohn’s Disease: Rationale, Clinical Results and Perspectives

Buscail

Cosquer

Gross

et al. 2021

IJMS

Between 20 to 25% of Crohn’s disease (CD) patients suffer from perianal fistulas, a marker of disease severity. Seton drainage combined with anti-TNFα can result in closure of the fistula in 70 to 75% of patients. For the remaining 25% of patients there is room for in situ injection of autologous or allogenic mesenchymal stem cells such as adipose-derived stem/stromal cells (ADSCs). ADSCs exert their effects on tissues and effector cells through paracrine phenomena, including the secretome and extracellular vesicles. They display anti-inflammatory, anti-apoptotic, pro-angiogenic, proliferative, and immunomodulatory properties, and a homing within the damaged tissue. They also have immuno-evasive properties allowing a clinical allogeneic approach. Numerous clinical trials have been conducted that demonstrate a complete cure rate of anoperineal fistulas in CD ranging from 46 to 90% of cases after in situ injection of autologous or allogenic ADSCs. A pivotal phase III-controlled trial using allogenic ADSCs (Alofisel®) demonstrated that prolonged clinical and radiological remission can be obtained in nearly 60% of cases with a good safety profile. Future studies should be conducted for a better knowledge of the local effect of ADSCs as well as for a standardization in terms of the number of injections and associated procedures.