Management of patients with complex perianal fistulas in Crohn's disease: Optimal patient flow in the Italian clinical reality

Spinelli, Antonino; Armuzzi, Alessandro; Ciccocioppo, Rachele; Danese, Silvio; Gionchetti, Paolo; Luglio, Gaetano; Orlando, Ambrogio; Rispo, Antonio; Rizzello, Fernando; Sofo, Luigi; Solina, G.; Poggioli, Gilberto

doi:10.1016/j.dld.2019.11.016

Cited by 18 publications

(19 citation statements)

References 85 publications

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“…The general goal of therapy is healing, defined as no drainage with gentle compression on the external fistula orifice for a duration of 1 month [6]. In the acute phase, the primary focus is first to gain source control of sepsis followed by inducing remission of active luminal disease and achieving mucosal healing [25,26]. Abscesses requiring drainage occur in approximately 60% of CD patients with perianal involvement [27,28].…”

Section: Managementmentioning

confidence: 99%

Management of Hospitalized Patients with Fistulizing Crohn’s and Crohn’s-Related Abscess

Chibbar

Flier

2021

Management of Inpatient Inflammatory Bowel Disease

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Section: Managementmentioning

confidence: 99%

Management of Hospitalized Patients with Fistulizing Crohn’s and Crohn’s-Related Abscess

Chibbar

Flier

2021

Management of Inpatient Inflammatory Bowel Disease

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“…[1][2][3][4][5][6][7][8][9][10] In approximately 10%, perianal fistulas are the first manifestation of Crohn's disease (CD) and in 5% they remain the only disease manifestation. 1,3,4,9,11,12 Cumulative risk increases with longer CD duration and PFCD is more common with distal luminal disease particularly in active proctitis. 1,2,4,10,12,13 Furthermore, longstanding PFCD is a risk factor for definitive stoma formation and development of anal carcinoma.…”

mentioning

confidence: 99%

“…1,3,4,9,11,12 Cumulative risk increases with longer CD duration and PFCD is more common with distal luminal disease particularly in active proctitis. 1,2,4,10,12,13 Furthermore, longstanding PFCD is a risk factor for definitive stoma formation and development of anal carcinoma. [4][5][6]12 The etiology of perianal fistulas in CD remains incompletely understood.…”

mentioning

confidence: 99%

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The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases: Combined Medical-Surgical Treatment in Complex Perianal Fistulas in CD

Geldof

Iqbal

Warusavitarne

et al. 2022

Clin Colon Rectal Surg

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Perianal fistulizing Crohn's disease (PFCD) represents a challenging and complex disease phenotype. Patients typically suffer a more severe disease course than those without perianal complications and are often managing debilitating symptoms. Etiology is understood to be multifactorial, with genetic predisposition, microbiological insult, aberrant immunity, and mechanical factors all implicated. As a result, multimodal treatment strategies must be employed to achieve disease control and fistula closure. This requires the complimentary involvement of medical and surgical disciplines in order to ensure thorough assessment and treatment tailored to the individual scenario and patient goals. The aim of this article is to describe an overview of the various treatment strategies available for PFCD, focusing on how a synergistic approach is required to ensure maximal chances of success.

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“…Failure of approved therapies and in some cases the inability to provide a surgical treatment because of physical extension and/or mislocation of lesions are still major challenges to the management of IBD. 3 , 4 In the absence of a definitive cure, better understanding of the pathophysiology of IBD is necessary to improve disease outcomes and prevention as well as to discover new effective and lasting treatments.…”

mentioning

confidence: 99%

PGI2 Inhibits Intestinal Epithelial Permeability and Apoptosis to Alleviate Colitis

Pochard

Gonzalès

Bessard

et al. 2021

Cellular and Molecular Gastroenterology and Hepatology

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This study questions reduced prostacyclin production in mucosa from inflammatory bowel disease patients and highlights prostacyclin regulation of the intestinal epithelial barrier. Combining mouse model and human sample analyses, we demonstrated that prostacyclin prevented colitis and occludin down-regulation, inhibited apoptosis, induced occludin membrane location, and reduced intestinal epithelial permeability.BACKGROUND & AIMS: Inflammatory bowel diseases (IBDs) that encompass both ulcerative colitis and Crohn's disease are a major public health problem with an etiology that has not been fully elucidated. There is a need to improve disease outcomes and preventive measures by developing new effective and lasting treatments. Although polyunsaturated fatty acid metabolites play an important role in the pathogenesis of several disorders, their contribution to IBD is yet to be understood. METHODS:Polyunsaturated fatty acids metabolite profiles were established from biopsy samples obtained from Crohn's disease, ulcerative colitis, or control patients. The impact of a prostaglandin I 2 (PGI 2 ) analog on intestinal epithelial permeability was tested in vitro using Caco-2 cells and ex vivo using human or mouse explants. In addition, mice were treated with PGI 2 to observe dextran sulfate sodium (DSS)-induced colitis. Tight junction protein expression, subcellular location, and apoptosis were measured in the different models by immunohistochemistry and Western blotting.RESULTS: A significant reduction of PGI 2 in IBD patient biopsies was identified. PGI 2 treatment reduced colonic inflammation, increased occludin expression, decreased caspase-3 cleavage and intestinal permeability, and prevented colitis development in DSS-induced mice. Using colonic explants from mouse and human control subjects, the staurosporine-induced increase in paracellular permeability was prevented by PGI 2 . PGI 2 also induced the membrane location of occludin and reduced the permeability observed in colonic biopsies from IBD patients. CONCLUSIONS:The present study identified Q7 a PGI 2 defect in the intestinal mucosa of IBD patients and demonstrated its protective role during colitis.

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Management of patients with complex perianal fistulas in Crohn's disease: Optimal patient flow in the Italian clinical reality

Cited by 18 publications

References 85 publications

Management of Hospitalized Patients with Fistulizing Crohn’s and Crohn’s-Related Abscess

Management of Hospitalized Patients with Fistulizing Crohn’s and Crohn’s-Related Abscess

The Essential Role of a Multidisciplinary Approach in Inflammatory Bowel Diseases: Combined Medical-Surgical Treatment in Complex Perianal Fistulas in CD

PGI2 Inhibits Intestinal Epithelial Permeability and Apoptosis to Alleviate Colitis

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