Long-term MRI-guided combined anti-TNF-α and thiopurine therapy for crohnʼs perianal fistulas

Abstract

Combination anti-TNF and thiopurine therapy provides sustained benefit in patients with perianal CD fistula. Early clinical response is associated with subsequent clinical remission. Radiological healing is slower than clinical healing. Radiologically healed fistula tracts maintain healing on infliximab but can recur after cessation of therapy.

Volume assessment magnetic resonance imaging technique for monitoring perianal Crohn’s fistulas

“…8,12 However, there has been no objective method for quantification of fistula volume and this has therefore not been included in MRI scoring systems to date. 8,12,17,19 Studies of surgical treatment have also struggled to identify a robust, objective measure of radiological improvement. 20 The present study has shown that volume of perianal fistula in patients with CD can be reliably measured by MRI with very good inter-and intra-observer agreement.…”

“…10 CD is a chronic relapsing and remitting disease as are its fistulising complications, 11 so clinical remission cannot be determined at individual time points, as the very nature of discharge is sporadic. Furthermore, closure of an external opening does not necessarily equate to deep healing of the tracts, 12 or indeed improved quality of life. 8 Pelvic MRI has been shown to be the most accurate method for classification of the primary tract and secondary extensions; 13 the recognition and treatment of the latter being essential to ensure satisfactory healing.…”

“…8 Assessment of radiological improvement is subjective and wide variation exists between radiologists. Previous attempts to standardize radiological response, such as the Van Assche system, have been criticised due to insensitivity to change, 8,12 and represent descriptive scores rather than monitoring tools. Currently, there is no universally accepted or reliable method of monitoring longterm radiological response to treatment.…”

P508 Response of hepatitis B vaccination in patients with inflammatory bowel disease; prospective observational study in Korea

“…2 The aim of this study was to review long-term outcomes of patients treated with biological therapy for perianal Crohn's fistula at our institution. Methods: A local database of patients treated at our tertiary institution from 2005 to 2016 was established for patients on biologic (anti-TNF) therapy.…”

Rol de infliximab en enfermedad inflamatoria intestinal: Experiencia local

“…En pacientes con EC y compromiso inflamatorio se consideró remisión endoscópica de la mucosa a un puntaje ≤ 2, según el score endoscópico SES-CD 21,22 . En pacientes con EC y compromiso perianal se consideró una buena respuesta radiológica la reducción de la fístula a lo menos en 50% en el control por RM de pelvis 23 .…”