Burden and outcomes for complex perianal fistulas in Crohn’s disease: Systematic review

Abstract

AIMTo systematically review the literature on epidemiology, disease burden, and treatment outcomes for Crohn’s disease (CD) patients with complex perianal fistulas.METHODSPubMed, Embase, and Cochrane were searched for relevant articles (published 2000-November 2016) and congress abstracts (published 2011-November 2016).RESULTSOf 535 records reviewed, 62 relevant sources were identified (mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14% (follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment (failure and relapse rates, respectively: medical, 12%-73% and 0%-41%; surgical: 0%-100% and 11%-20%; combined medical/surgical: 0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies (1 of infliximab; 3 of surgical interventions) have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD.CONCLUSIONComplex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to anti-tumour necrosis factor-α agents, as evidenced by high failure and relapse rates.

Tratamento da fístula anal com extrato de Baccharis dracunculifolia. Estudo experimental em ratos.

“…In a study on tissue inflammation with and without B. dracunculifolia in the rat diet, the authors have confirmed that those treated with the plant have had a significant reduction in the inflammatory process, characterized by a reduction in neutrophil concentration and a decrease in vascular congestion 21,22 . In the present research, a reduction in vascular congestion was also observed, There is a series of evidences that anal fistulas can be completely cured with the use of stem cells, which have been tested mainly on complex fistulas in Crohn's disease 23 . A very interesting research has shown that B. dracunculifolia can promote stem cell proliferation, differentiation, and in vitro migration to the applied site 24 , which could theoretically contribute to the closure of the fistulous tracts.…”

Crohn’s Disease: Hematopoietic and Mesenchymal Stem Cell Therapy as Potential Treatment

“…In Figure 2 below, a systematic review of CD found the percentage of real-world treatment options being used. Thiopurines and medication-based treatment are currently the most practiced option [13]. Retrospective single center study [13] However, 30% of patients who have surgery for Crohn's disease experience recurrence of their symptoms within three years and up to 60% will have a recurrence within ten years.…”

Application of tissue engineering in perianal Crohn´s Disease

“…Una de las complicaciones más relevantes que pueden presentar estos pacientes es el desarrollo de fístulas perianales. Se estima que el 26% de los pacientes con EC las desarrollaran en las dos primeras décadas tras el diagnóstico (1,2). Entre las opciones de tratamiento llevadas a la práctica actualmente, se encuentran las terapias médicas con mesalazina, corticoesteroides sistémicos, anti-TNF o la cirugía.…”