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Recent advances in clinical practice
Modern management of perianal fistulas in Crohn’s disease: future directions
  1. Paulo Gustavo Kotze1,
  2. Bo Shen2,
  3. Amy Lightner3,
  4. Takayuki Yamamoto4,
  5. Antonino Spinelli5,
  6. Subrata Ghosh6,
  7. Remo Panaccione1
  1. 1 Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
  2. 2 Interventional IBD Unit, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  3. 3 Division of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan
  5. 5 Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy
  6. 6 Institute of Translational Medicine, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Paulo Gustavo Kotze, Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Parana, Curitiba PR 80045-165, Brazil; pgkotze{at}hotmail.com

Abstract

Perianal fistulae in patients with Crohn’s disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.

  • crohn’s disease
  • perianal fistula
  • biologics
  • colorectal surgery
  • therapeutic endoscopy

https://doi.org/10.1136/gutjnl-2017-314918

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    Footnotes

    • Contributors PGK, BS, AL, TY, AS, SG and RP drafted the article. RP, PGK and SG reviewed the final version and all authors gave final approval for publication.

    • Disclaimer PGK has received speaking and consultancy honoraria from AbbVie, Janssen, Pfizer, Takeda and UCB. BS has received speaking and consultancy honoraria from AbbVie, Janssen and Takeda. AL and AS have served as consultants to Takeda. SG has served as Steering Committee member to Pfizer, AbbVie, Janssen, Aerpio, Receptos, Takeda, Bristol-Myers Squibb, Novo Nordisk, Shire, Ferring and has received research support from AbbVie and speaker fee from AbbVie, Takeda, Falk Pharma and Janssen. RP has received research/educational support from AbbVie, Abbott, Ferring, Janssen, Schering-Plough, Centocor, Millennium, Elan, Procter & Gamble and Bristol-Myers Squibb. He has served as a consultant for AbbVie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Janssen, Merck, Schering-Plough, Shire, Centocor, Elan, GlaxoSmithKline, UCB, Pfizer, Bristol-Myers Squibb, Warner Chilcott, Takeda, Cubist, Celgene, Gilead Sciences and Takeda. RP has also participated on speaker’s bureaus for AbbVie, AstraZeneca, Janssen, Schering- Plough, Shire, Ferring, Centocor, Elan, Prometheus, Warner Chilcott and Takeda. He has attended Advisory Boards for AbbVie, Abbott, Amgen, Aptalis, AstraZeneca, Baxter, Eisai, Ferring, Genentech, Janssen, Merck, Schering-Plough, Shire, Centocor, Elan, GlaxoSmithKline, UCB, Pfizer, Bristol-Myers Squibb, Warner Chilcott, Takeda, Cubist, Celgene and Salix.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.