European evidence based consensus on the diagnosis and management of Crohn's disease: special situations

Caprilli, R.; Gassull, M. A.; Escher, Johanna C.; Moser, Gabriele; Munkholm, Pia; Forbes, Alastair; Hommes, Daniël W.; Lochs, Herbert; Angelucci, E.; Cocco, Andrea; Vucelić, Boris; Hildebrand, Hans; Kolaček, Sanja; Riis, Lene; Lukáš, Milan; Franchis, Roberto de; Hamilton, Mark; Jantschek, Günter; Michetti, Pierre; O’Moráin, Colm; Anwar, Malik M.; Freitas, J.; Mouzas, Ioannis; Baert, Filip; Mitchell, Rod; Hawkey, C. J.

doi:10.1136/gut.2005.081950c

Cited by 396 publications

(347 citation statements)

References 312 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]. As only 50% of patients respond to this therapy, predictors for selection of patients for antibiotic treatment are crucial [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Usually infliximab is recommended as second-line treatment for Crohn 0 s perianal fistulas when first-line treatment (antibiotics and/or azathioprine/6-mercaptopurine) fails [4,11]. Nevertheless, given the low response rate of Crohn 0 s perianal fistulas to antibiotics and/or azathioprine/6-mercaptopurine and the encouraging results of infliximab in this setting, some authors consider a ''topdown'' approach as an option for these patients [4,[11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, given the low response rate of Crohn 0 s perianal fistulas to antibiotics and/or azathioprine/6-mercaptopurine and the encouraging results of infliximab in this setting, some authors consider a ''topdown'' approach as an option for these patients [4,[11][12][13][14][15][16]. Our results, demonstrating that CARD15 genotype seems to predict clinical response of perianal fistulas to antibiotics, suggest that CARD15 genotype may be a factor in selection of patients with perianal fistulas for a ''top-down'' approach.…”

Section: Discussionmentioning

confidence: 99%

“…Although treatments for fistulizing perianal CD have evolved greatly over the past decade, antibiotics remain widely used and are the recommended first-line treatment for these patients, despite the absence of controlled studies to support this approach [4,11]. However, the response rate of perianal fistulas to antibiotics is only around 50% [12][13][14][15][16].…”

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…Th e 2003 position paper from the American Gastroenterological Association took the fi rst step in this direction by advocating EUS or MRI in addition to EUA for all patients with pain, fl uctuation, or stricture on rectal examination (15) . Th e more recent ECCO (European Crohn ' s and Colitis Organization) guidelines for the management of Crohn ' s disease went a step further, recommending imaging with MRI or EUS for all fi stulas for which medical and / or surgical treatment was being considered (16) .…”

mentioning

confidence: 99%

Imaging and the Treatment of Crohnʼs Perianal Fistulas

Schwartz

2009

American Journal of Gastroenterology

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Fistulizing Crohn ' s disease is associated with signifi cant morbidity. Although treatment has improved over the last decade, there is still considerable room for improvement. One possible method to improve outcomes is to use advanced imaging techniques, such as endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI), to help guide treatment. In this issue, Ng et al. show again the disconnect between cessation of drainage and the actual deep healing that can be appreciated using these imaging techniques. The authors used MRI to help guide the decision on when to alter medical therapy and were able to identify a subset of patients who could discontinue infl iximab. Other authors over the last 5 -10 years have also shown the benefi t of EUS and MRI in these patients. The time has come for us to not only embrace these imaging modalities as valid end points for clinical trials but more importantly as a means to improve outcomes for our patients with fi stulizing Crohn ' s disease.

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Infliximab With Low-Dose Methotrexate for Prevention of Postsurgical Recurrence of Ileocolonic Crohn Disease

Sorrentino¹,

Terrosu²,

Avellini³

et al. 2007

Arch Intern Med

115

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European evidence based consensus on the diagnosis and management of Crohn's disease: special situations

Cited by 396 publications

References 312 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

Imaging and the Treatment of Crohnʼs Perianal Fistulas

Infliximab With Low-Dose Methotrexate for Prevention of Postsurgical Recurrence of Ileocolonic Crohn Disease

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