Patients with perianal Crohn's fistulas experience delays in accessing anti‐<scp>TNF</scp> therapy due to slow recognition, diagnosis and integration of specialist services: lessons learned from three referral centres

Lee, Matthew J.; Freer, C. E. L.; Adegbola, S; Elkady, Soad; Parkes, Miles; Hart, Ailsa; Fearnhead, Nicola; Lobo, AJ; Brown, S. R.

doi:10.1111/codi.14102

Cited by 14 publications

(15 citation statements)

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“…We believe that OE could be an efficacious answer to the issues recently underlined by Lee et al [15] and those reported above. OE can be a part of a clinical pathway for patients with perianal Crohn's fistulas.…”

Section: Discussionmentioning

confidence: 59%

“…[13,14]. Early diagnosis and correct treatment are crucial to allow patients to promptly start medical treatments with antitumor necrosis factor (tnf) which is considered the cornerstone of treatment, offering the best long-term control of PAD [15,16]. The diagnosis and treatment may be delayed since the clinical pathway for this subset of patients is still not fully standardized, even in specialized centers.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis and treatment may be delayed since the clinical pathway for this subset of patients is still not fully standardized, even in specialized centers. Recently, a delay in many elements of the clinical pathway in patients with Crohn's anal fistula has been reported [15], and it was seen that the commencement of the anti-tnf therapy could be as long as one year. Resolving the delay is also important to reduce the debility associated with PAD.…”

Section: Discussionmentioning

confidence: 99%

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Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility

Sibio

Giorgio

Campanelli

et al. 2018

Gastroenterology Research and Practice

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Background. One-third of Crohn’s disease (CD) patients present perianal fistula. The gold standard in the diagnosis and treatment of symptomatic perianal disease (PAD) in CD is the exploration of the anal canal and distal rectum under anesthesia (EUA). This procedure is mainly conducted as a day case surgery. Unfortunately, it is not always possible to proceed within the ideal timing and any delay may well represent a relevant clinical issue. The aim of this study was to evaluate the feasibility of outpatient treatment of symptomatic perianal fistulas in CD patients. Methods. All CD patients under regular follow-up at our inflammatory bowel disease referral center, presenting with symptomatic perianal fistulas, were offered surgical consultation. The data of patients were prospectively collected for three years (February 2014 to February 2017) for the purpose of the study. All clinical information, including previous EUA and/or records from MRI and endoscopic ultrasound, was included. Outpatient anal canal and distal rectum exploration and treatment (OE) were undertaken during the specialist surgical consultation. Fistulas were classified according to Parks’s classification; the type of outpatient treatment and compliance of patients were recorded. Pain was assessed by VAS at the time of the procedure and during the first control. Patients were followed up in the surgical clinic in relation to the study. Results. Ninety-two CD patients with symptomatic perianal fistulas had surgical consultation during the study period. OE was offered to all but 18 patients who fulfilled the exclusion criteria or had an extremely severe disease; six patients refused the OE (8.11%). Of the 68 patients undergoing OE, eleven (16.18%) had previous surgery for perianal disease. The OE was accomplished in sixty-one patients (89.71%), while in 7 patients, it was abandoned for scarce compliance. Nine patients (14.75%) underwent drainage of perianal abscess; in 3 of them, it was possible to probe the fistula tract, find the internal orifice, and pass a loose seton. Overall, setonage was performed in 50 patients (81.97%). Rectovaginal setons were placed in 3 patients and more than one seton (up to 3) in 6 cases. Fistulotomy was performed in 4 simple subcutaneous fistulous tracts. Concordance with the preoperative findings was found in 54 out of 61 patients. EUA was scheduled at the time of OE for the 7 patients who did not complete the procedure. All sixty-one patients who had the OE were followed up for a minimum of 12 months. Conclusions. This preliminary study indicates that OE in CD patients with symptomatic perianal fistulas is safe and feasible in a high-volume referral center. It might provide several benefits, including patients’ logistics, reduce or remove patients’ symptoms and discomfort, allow for a timely start of medical therapy, and avoid further complications.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ambulatory Surgery for Perianal Crohn’s Disease: Study of Feasibility

Sibio

Giorgio

Campanelli

et al. 2018

Gastroenterology Research and Practice

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show abstract

“…Symptomatic anal fistula in patients with Crohn’s disease (CD) requires proper and timely treatment in order to avoid perianal sepsis and allow prompt initiation of anti‐TNF‐alpha treatment [1]. Guidelines and clinical recommendations specific for this period of global crisis for inflammatory bowel disease (IBD) suggest that IBD is treated as usual and recommend that any therapy should be administered while minimizing exposure of people and potential transmission [2].…”

mentioning

confidence: 99%

Ambulatory management of perianal Crohn’s disease during the COVID‐19 pandemic

2020

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“…Management of patients with fistulating perianal Crohn's disease is especially complex as optimal therapy involves surgical stabilization of disease with drainage and seton insertion followed by biological therapy . We have shown that the median time from presentation of symptoms to initiation of biological therapy is 7 months in three major UK teaching hospitals and 25% of patients wait longer than 18 months even when the diagnosis of Crohn's disease is known .…”

mentioning

confidence: 99%