Course and Treatment of Perianal Disease in Children Newly Diagnosed with Crohnʼs Disease

Abstract

Approximately 10% of newly diagnosed pediatric patients with Crohn's disease will have perianal fistulas and/or abscesses at the time of diagnosis. Most of these will resolve within a year with medical therapy alone.

Predictors of response to infliximab in paediatric perianal Crohn's disease

“…1,2 Treatment of perianal lesions has long been dismaying, with high rates of recurrence and proctectomy in adult population-based studies before the era of biologic therapies. 3 Infliximab (IFX) was the first anti-TNF agent to show efficacy in fistula closure.…”

Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion

“…15,21 Other than abscesses, most perianal lesions of Crohn's disease respond to medical therapy without surgery. 22 This finding suggests that surgery for Crohn's disease-related perianal lesions other than abscesses may not be beneficial and could result in worse outcomes than medical therapy. A clear causal relationship has not been established linking surgical procedures to fistula development, and we could not establish causality in this study.…”

Induction and Maintenance Infliximab Therapy for the Treatment of Crohn’s Disease with Perianal Fistulas in Children: Retrospective, Multicenter Study

“…Biological treatment with TNF-alfa inhibitors improve the condition of intestinal mucosa, and diminish the number of hospital admissions and surgeries [20,26]. The results of the treatment of fistulas are also improved [6,13,17,19,[27][28][29][30][31]. However, there is a lack of credible studies on the prevention of fistulas in Crohn's disease in children.…”

“…The disease in children is characterized by abdominal pain, chronic diarrhea, bloody stools, fever, arrest of the growth and sexual development as well as perianal changes with abscesses, fistulas and extraintestinal symptoms [4][5]. According to Keljo et al [6] frequency of perianal changes such as skin tags, fissures, fistulas, abscesses and rectal strictures ranges from 13.6% to 62%. Palder et al [7], in analysis of Crohn's disease in 325 children, observed that perianal changes had developed in 62% of them.…”

“…In the patients with uncertain diagnosis, speciments from condylomata can be sampled and examined for granulomas, which are present in 30% of the patients with Crohn's disease. Treatment of fistulas is most difficult which in turn may lead to constipation, stool incontinence, recurrent infections and sepsis as well as to a decrease in life quality and surgery [6,12].…”