Perianal Fistulas in Crohn’s Disease Are Predominantly Colonized by Skin Flora: Implications for Antibiotic Treatment?

West, Rachel; Woude, Christien J. van der; Endtz, Hubert P.; Hansen, Bettina E.; Ouwedijk, M; Boelens, Hélène; Kusters, JG; Kuipers, E.J.

doi:10.1007/s10620-005-2769-4

Cited by 39 publications

(31 citation statements)

References 9 publications

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“…Nevertheless, there is evidence suggesting that luminal bacteria might play a role in development and maintenance of fistulas [18,[39][40][41]. Perhaps for this reason, antibiotics are a widely used and recommended first-line treatment for fistulas in CD patients, despite the near absence of randomized controlled trials supporting this approach [4,11].…”

Section: Discussionmentioning

confidence: 99%

“…The specific pathogenesis of Crohn 0 s perianal fistulas is unknown, but luminal bacteria seem to play a role in their development and maintenance [18]. Since CARD15 mutations increase susceptibility to CD and appear to change the host response to luminal bacteria, it is reasonable to speculate on a possible connection between this gene and perianal fistulas [19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…The transmural inflammation that typifies Crohn's disease predisposes these patients to fistula formation; luminal bacteria might also have a role in the development and maintenance of fistulas. 11 In one study, histomorphologic characterization of fistulas resected from patients with Crohn's disease revealed a central fissure that penetrated through the lamina propria and muscularis mucosae into the deeper layers of the underlying tissue ( Figure 4). 12 The fistulas were surrounded by granulation tissue with histiocytes and a tight network of capillaries, and 27% of fistulas were covered by a layer of clearly recognizable epithelial cells, with tight junctions and a basement membrane.…”

Section: Pathogenesismentioning

confidence: 99%

Diagnosis and management of fistulizing Crohn's disease

Nielsen

Rogler

Hahnloser

et al. 2009

Nat Rev Gastroenterol Hepatol

113

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The transmural inflammation characteristic of Crohn's disease predisposes patients to the formation of fistulas. Up to 50% of patients with Crohn's disease are affected by fistulas, which is a major problem given the considerable morbidity associated with this complication. Appropriate treatment of fistulas requires knowledge of specific pharmacological and surgical therapies. Treatment options depend on the severity of symptoms, fistula location, the number and complexity of fistula tracts, and the presence of rectal complications. Internal fistulas, such as ileoileal or ileocecal fistulas, are mostly asymptomatic and do not require intervention. By contrast, perianal fistulas can be painful and abscesses may develop that require surgical drainage with or without seton placement, transient ileostomy, or in severe cases, proctectomy. This Review describes the epidemiology and pathology of fistulizing Crohn's disease. Particular focus is given to external and perianal fistulas, for which treatment options are well established. Available therapeutic options, including novel therapies, are discussed. Wherever possible, practical and evidence-based treatment regimens for Crohn's disease-associated fistulas are provided.

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“…9 Treatment with metronidazole has been reported to result in the closure of perianal fistulae in 34%-83% of CD patients. [10][11][12][13][14] Although clinical improvement of perianal fistulae was observed following 6-8 weeks administration of metronidazole, discontinuation of the antibiotic resulted in fistula recurrence, 12,14 suggesting a requirement for long-term use.…”

Section: Traditional Approaches For Fistula Treatment Medicalmentioning

confidence: 99%

Perianal fistulae in Crohnʼs Disease: Current and future approaches to treatment

Keshaw¹,

Foong²,

Forbes³

et al. 2010

Inflammatory Bowel Diseases

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: affecting sphincter integrity and continence. Traditional surgical and medical approaches are not without their limitations and may result in either comorbidity, such as fecal incontinence, or incomplete healing of the fistulae. Over the last 2 decades these limitations have led to a paradigm shift toward the use of biomaterials, and more recently cell-based therapies, which have met with variable degrees of success. This review discusses the traditional and current methods of treatment, as well as emerging and possible alternative approaches that may improve fistula healing.

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Perianal Fistulas in Crohn’s Disease Are Predominantly Colonized by Skin Flora: Implications for Antibiotic Treatment?

Cited by 39 publications

References 9 publications

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

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

Diagnosis and management of fistulizing Crohn's disease

Perianal fistulae in Crohnʼs Disease: Current and future approaches to treatment

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