The Multidisciplinary Management of Perianal Fistulas in Crohn’s Disease: A Systematic Review

Abstract

Perianal fistulas in Crohn's disease (CD) are often recurring and challenging to treat. This systematic review aimed to evaluate the medical, surgical, and combination treatment options and provide an overview of their efficacy. We performed this systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Our group searched PubMed, Medline, PubMed Central, Google Scholar, and ScienceDirect for articles within the last ten years using different terms and criteria mentioned in detail in the search strategy and eligibility criteria sections. Initially, 739 records were retrieved, out of which we excluded 731 records for various reasons, such as irrelevant titles and abstracts and low scores on quality assessment tools. The evidence for combination (surgical and medical) therapy is superior to that for medical and surgical treatments individually. In contrast, the studies on medical and surgical treatments individually reported varied evidence and efficacy for their respective options.

Self-screening questionnaire for perianal fistulizing disease in patients with Crohn’s disease

“…Early detection of pCD enables the early use of appropriate antibiotics, thiopurines, and tumor necrosis factor (TNF)-α inhibitors, which possess strong evidence supporting their use in pCD treatment [ 6 , 7 ], and/or surgical drainage with seton insertion depending on whether the perianal fistula type is simple or complex [ 8 , 9 ]. Serious complications can be prevented through a timely and multidisciplinary approach such as anal stricture or total proctectomy with ileostomy [ 10 , 11 ].…”