Anal ulcerations in Crohn’s disease: Natural history in the era of biological therapy

Wallenhorst, Timothée; Brochard, Charlène; Balc’h, Eric Le; Bodere, Anaïs; Garros, Aurélien; Merlini-l’Heritier, Alexandre; Bouguen, Guillaume; Siproudhis, L.

doi:10.1016/j.dld.2017.07.014

Cited by 10 publications

(12 citation statements)

References 14 publications

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“…To the best of our knowledge, this is the first study to report the incidence rates of anal ulceration CD. Perianal CD is often reduced to fistulizing perianal CD 30,31 , while anal ulceration CD is frequent and associated with more severe disease in both luminal and perianal locations 31 . Importantly, anal ulceration at baseline was associated with the onset of fistulizing perianal CD in our study.…”

Section: Discussionmentioning

confidence: 99%

Natural History of Perianal Crohn's Disease: Long-term Follow-up of a Population-Based Cohort

Brochard

Rabilloud

Hamonic

et al. 2022

Clinical Gastroenterology and Hepatology

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Section: Discussionmentioning

confidence: 99%

Natural History of Perianal Crohn's Disease: Long-term Follow-up of a Population-Based Cohort

Brochard

Rabilloud

Hamonic

et al. 2022

Clinical Gastroenterology and Hepatology

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“…Another study of 154 CD patients with anal ulcers demonstrated that biologic or combination therapy (biologic þ immunomodulator) took 1 year to achieve healing, but interestingly, those with associated fistulizing disease had faster time to ulcer healing than non-fistulizing. 24 In a smaller study done in France, 79% (23/29) CD patients with anal ulcers and/or fissures demonstrated a clinical response by 8 weeks, and 49% experienced complete healing with long-term (week 24) healing rates of 63% (10/16). 25 For anal strictures specifically, a retrospective analysis of 22 patients initiating infliximab demonstrated a complete response rate of 55% (12/22), though 6/12 also had anal dilatation, potentially pointing toward improved efficacy with combination of medical and interventional approaches.…”

Section: Anti-tnfsmentioning

confidence: 97%

Anorectal Strictures in Complex Perianal CD: How to Approach?

Lightner

Regueiro

2022

Clin Colon Rectal Surg

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Anorectal strictures are a notoriously difficult to treat phenotype of perianal Crohn's disease. Quality of life is diminished due to ongoing pain, incontinence, difficulty with stool evacuation, and recurrent medical and surgical treatments. Medical therapy is aimed at treating luminal disease and mucosal ulceration to prevent worsening of fibrosis. Clinical examination and endoscopic intervention can be used for serial dilations of strictures. Unfortunately, despite optimal medical therapy and endoscopic intervention with serial anal dilations, surgery with intestinal diversion or proctocolectomy may be required as part of the treatment algorithm in a significant proportion of patients.

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“…Perianal disease may include fistulizing lesions (fistulas and abscesses) and non-fistulizing lesions (ulceration, fissures, and strictures/stenosis) [ 142 , 143 ]. Various classification systems have been developed to describe perianal disease both in terms of pathological type, anatomical extent, and severity.…”

Section: Consensus Recommendationsmentioning

confidence: 99%

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

et al. 2023

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Background We aimed to develop criteria for treatment intensification in patients with (1) luminal Crohn’s disease (CD), (2) CD with perianal disease and/or fistula, (3) CD with small bowel stenosis, (4) in the postoperative setting, and (5) for discontinuing or reducing the dose of treatment in patients with CD. Methods PubMed and Embase were searched for studies published since 1998 which may be relevant to the five defined topics. Results were assessed for relevant studies, with preference given to data from randomized, controlled studies. For each question, a core panel of 12 gastroenterologists defined the treatment target and developed statements, based on the literature, current guidelines, and relevant additional studies. The evidence supporting each statement was graded using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). A modified Delphi process was used to refine statements and gain agreement from 54 Japanese specialists at in-person and online meetings conducted between October 2020 and April 2021. Results Seventeen statements were developed for treatment intensification in luminal CD (targeting endoscopic remission), six statements for treatment intensification in perianal/fistulizing CD (targeting healing of perianal lesions and complete closure of the fistula), six statements for treatment intensification in CD with small bowel stenosis (targeting resolution of obstructive symptoms), seven statements for treatment intensification after surgery (targeting endoscopic remission), and five statements for discontinuing or reducing the dose of treatment in patients with CD. Conclusions These statements provide guidance on how and when to intensify or de-intensify treatment for a broad spectrum of patients with CD.

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Anal ulcerations in Crohn’s disease: Natural history in the era of biological therapy

Cited by 10 publications

References 14 publications

Natural History of Perianal Crohn's Disease: Long-term Follow-up of a Population-Based Cohort

Natural History of Perianal Crohn's Disease: Long-term Follow-up of a Population-Based Cohort

Anorectal Strictures in Complex Perianal CD: How to Approach?

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

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