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

Brochard, Charlène; Rabilloud, M.-L.; Hamonic, Stéphanie; Bajeux, Emma; Pagenault, Maël; Dabadie, A.; GERFAUD, Agathe; Viel, Jean‐François; Tron, Isabelle; Robaszkiewicz, Michel; Bretagne, Jean–François; Siproudhis, L.; Bouguen, Guillaume

doi:10.1016/j.cgh.2020.12.024

Cited by 23 publications

(13 citation statements)

References 35 publications

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“…perianal CD varied between 11% and 19% at 1-10 years after diagnosis. 9 In a study of 983 patients with CD in Asia, stricturing or penetrating CD occurred in 41% and perianal disease in 25% of patients. 10 At the other end of the spectrum, incidental terminal ileitis can be diagnosed in 1.6% of individuals undergoing nondiagnostic colonoscopy, with an uncertain but likely low rate of progression to overt CD.…”

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confidence: 99%

Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User’s Guide for Adult and Pediatric Gastroenterologists

et al. 2021

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Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, are chronic, progressive, immune-mediated diseases of adults and children that have no cure. IBD can cause significant morbidity and lead to complications such as strictures, fistulas, infections, and cancer. In children, IBD can also result in growth impairment and pubertal delays. IBD is highly heterogenous, with severity ranging from mild to severe and symptoms ranging from mild to debilitating. Delay in IBD diagnosis, especially in Crohn's disease, is common and associated with adverse outcomes. Early diagnosis and prompt institution of treatment are the cornerstones for improving outcomes and maximizing health. Early diagnosis requires a low threshold of suspicion and red flags to guide early specialist referral at the primary provider level. Although the armamentarium of IBD medications is growing, many patients will not respond to treatment, and the selection of first-line therapy is critical. Risk stratification of disease severity, based on clinical, demographic, and serologic markers, can help guide selection of first-line therapy. Clinical decision support tools, genomics, and other biomarkers of response to therapy and risk of adverse events are the future of personalized medicine. After starting appropriate therapy, it is important to confirm remission using objective end points (treat to target) with continued control of inflammation with adjustment of therapy using surrogate biomarkers (tight control). Lastly, IBD therapy extends far beyond medications, and other aspects of the overall health and wellbeing of the patient are critical. These include preventive health, nutrition, and psychobehavioral support addressing patients' concerns around complementary therapy and medication adherence, prevention of disability, and ensuring open communication.

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confidence: 99%

Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User’s Guide for Adult and Pediatric Gastroenterologists

et al. 2021

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“…Several studies have attempted to identify risk factors associated with CD-PAF. Colonic disease, especially rectal involvement, younger age at diagnosis, male sex, longer disease duration of CD, and extraintestinal manifestations have been associated with higher rates of CD-PAF (4,13,14). Emerging data have demonstrated that the use of corticosteroids is associated with an increased risk of PAF in CD, and early use of steroid-sparing therapy is associated with a decreased risk of PAF and fistula complications (15,16).…”

Section: Pathogenesismentioning

confidence: 99%

“…Fistulizing perianal disease is found in up to 25% of patients with Crohn's disease during their disease course (1)(2)(3). An additional 10% of patients have other perianal manifestations including fissures, stenosis, and skin tags.…”

Section: Introductionmentioning

confidence: 99%

Management of Perianal Crohn's Disease

et al. 2023

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Perianal Crohn's disease affects 25%-35% of patients with Crohn's disease and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health-related quality of life scores typically related to pain and fecal incontinence. In addition, patients with perianal Crohn's disease have higher rates of hospitalizations, surgeries, and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation and the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring, and a close follow-up. Surgical management is critical to drain abscesses before immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps, and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.

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“…A fistula is a common complication and aggressive phenotype of Crohn’s disease (CD) that affects approximately 30% of patients during their disease course [ 1 , 2 , 3 ]. Fistulas in CD can be classified into internal and external fistulas.…”

Section: Introductionmentioning

confidence: 99%

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

Wetwittayakhlang

Khoury

Hahn

et al. 2022

JCM

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Fistulizing Crohn’s disease (FCD) remains the most challenging aspect of treating patients with CD. FCD can occur in up to 30% of patients with CD and may lead to significant disability and impaired quality of life. The optimal treatment strategies for FCD require a multidisciplinary approach, including a combined medical and surgical approach. The therapeutic options for FCD are limited due to sparse evidence from randomized clinical trials (RCTs). The current recommendations are mainly based on post hoc analysis from RCTs, real-world clinical studies and expert opinion. There is variation in everyday clinical practice amongst gastroenterologists and surgeons. The evidence for anti-tumor necrosis factor therapy is the strongest in the treatment of FCD. However, long-term fistula healing can be achieved in only 30–50% of patients. In recent years, emerging data in the advent of therapeutic modalities, including the use of new biologic agents, therapeutic drug monitoring, novel surgical methods and mesenchymal stem cell therapy, have been shown to improve outcomes in achieving fistula healing. This review summarizes the existing literature on current and emerging therapies to provide guidance beyond RCTs in managing FCD.

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

Abstract: Marie-Laure RABILLOUD and Emma BAJEUX declare no conflict of interest Acknowledgments: All physicians who included patients in the ABERMAD registry particularly to Etienne Cruchant, Jean-Luc Alexandre et Jacques-Arnaud Seyrig members of the scientific committee of ABERMAD.

Cited by 23 publications

References 35 publications

Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User’s Guide for Adult and Pediatric Gastroenterologists

Approach to the Management of Recently Diagnosed Inflammatory Bowel Disease Patients: A User’s Guide for Adult and Pediatric Gastroenterologists

Management of Perianal Crohn's Disease

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

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