Nonfistulizing perianal Crohnʼs disease

Bouguen, Guillaume; Siproudhis, L.; Bretagne, Jean–François; Bigard, Marc‐André; Peyrin–Biroulet, Laurent

doi:10.1002/ibd.21261

Cited by 50 publications

(20 citation statements)

References 63 publications

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“…The demographic characteristics and clinical remission rates of our patients are comparable to those of other studies[32,33]. The percentage of anorecto-vaginal fistulas in our study (20.4%) was higher than that described in the first study but similar to the most recent ones[34-36].…”

Section: Discussionsupporting

confidence: 89%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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AIMTo evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission.METHODSAll patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses.RESULTSForty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission.CONCLUSIONDeep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

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Section: Discussionsupporting

confidence: 89%

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Thomassin¹,

Armengol-Debeir²,

Charpentier³

et al. 2017

WJG

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“…Studies not written in English (9 studies) [21-29] were excluded (unless an English abstract was available). Studies that were purely review articles (4 studies) [30-33] or letters to the editor (3 publications) [34-36] that did not present any new or unique data were also excluded. Finally, studies that published repeated data and not new or unique data (2 studies) [37,38] were excluded.…”

Section: Methodsmentioning

confidence: 99%

Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis

Rossignol¹

2012

Medical Gas Research

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BackgroundTraditionally, hyperbaric oxygen treatment (HBOT) has been used to treat a limited repertoire of disease, including decompression sickness and healing of problem wounds. However, some investigators have used HBOT to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.MethodsComprehensive searches were conducted in 8 scientific databases through 2011 to identify publications using HBOT in IBD. Human studies and animal models were collated separately.ResultsThirteen studies of HBOT in Crohn's disease and 6 studies in ulcerative colitis were identified. In all studies, participants had severe disease refractory to standard medical treatments, including corticosteroids, immunomodulators and anti-inflammatory medications. In patients with Crohn's disease, 31/40 (78%) had clinical improvements with HBOT, while all 39 patients with ulcerative colitis improved. One study in Crohn's disease reported a significant decrease in proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) and one study in ulcerative colitis reported a decrease in IL-6 with HBOT. Adverse events were minimal. Twelve publications reported using HBOT in animal models of experimentally-induced IBD, including several studies reporting decreased markers of inflammation or immune dysregulation, including TNF-alpha (3 studies), IL-1beta (2 studies), neopterin (1 study) and myeloperoxidase activity (5 studies). HBOT also decreased oxidative stress markers including malondialdehyde (3 studies) and plasma carbonyl content (2 studies), except for one study that reported increased plasma carbonyl content. Several studies reported HBOT lowered nitric oxide (3 studies) and nitric oxide synthase (3 studies) and one study reported a decrease in prostaglandin E2 levels. Four animal studies reported decreased edema or colonic tissue weight with HBOT, and 8 studies reported microscopic improvements on histopathological examination. Although most publications reported improvements with HBOT, some studies suffered from limitations, including possible publication and referral biases, the lack of a control group, the retrospective nature and a small number of participants.ConclusionsHBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD.

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“…Primary lesions are caused by intestinal inflammation and include superficial fissures, deep cavitating anal canal ulcers and lymphedema 1, 2 . Secondary lesions are fistulas and abscess.…”

Section: Introductionmentioning

confidence: 99%

“…Secondary lesions are fistulas and abscess. Strictures are associated with primary or secondary perianal lesions or are a long-term consequence of the inflammatory process 1, 2 . Hemorrhoids are incidental lesions that are not directly related to Crohn’s disease.…”

Section: Introductionmentioning

confidence: 99%

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Perianal Crohnʼs disease findings other than fistulas in a population-based cohort

Peyrin-Biroulet

Loftus

Harmsen

et al. 2012

Inflammatory Bowel Diseases

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Background and aims The cumulative incidence of and risk factors for perianal Crohn’s disease for findings other than fistulas are unknown. Methods The medical records of 310 incident cases of Crohn’s disease from Olmsted County, Minnesota, diagnosed between 1970 and 2004, were reviewed for evidence of perianal disease findings other than fistulas. Cumulative incidence was estimated using the Kaplan-Meier method, and associations between baseline factors and time to first event were assessed using proportional hazards regression. Four types of lesions were studied: anorectal strictures, deep anal canal ulcers, anal fissures, and perianal skin tags. Results The 10-year cumulative probability from time of diagnosis was 5.8% (95% confidence interval [CI], 2.6%-8.8%) for anorectal strictures, 6.6% (3.6%-9.6%) for deep anal canal ulcers, 10.5% (6.8%-14.1%) for anal fissures, and 18.7% (13.9%-23.3%) for perianal skin tags. The cumulative probability for any perianal lesion other than fistulas was 21.3% (16.5%-25.8%) at 5 years and 29.2% (23.5%-34.5%) at 10 years. Baseline factors associated with time to first perianal lesion other than fistulas were age (hazard ratio [HR] per 10 years, 0.9; 95% CI, 0.8-0.98; p=0.026), female gender (HR, 1.7; 95% CI, 1.1-2.7; p=0.013), and presence of extraintestinal manifestations (HR, 1.7; 95% CI, 1.03-2.8; p=0.038). Conclusion Perianal lesions other than fistulas occurred frequently during the clinical course of Crohn’s disease. Female gender and extraintestinal manifestations were associated with increased risks for perianal lesions other than fistulas, while older age at diagnosis was associated with a slightly decreased risk.

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Nonfistulizing perianal Crohnʼs disease

Cited by 50 publications

References 63 publications

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease

Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis

Perianal Crohnʼs disease findings other than fistulas in a population-based cohort

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