RT Journal Article
SR Electronic
T1 A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1381
OP 1392
DO 10.1136/gutjnl-2013-306709
VO 63
IS 9
A1 Krisztina B Gecse
A1 Willem Bemelman
A1 Michael A Kamm
A1 Jaap Stoker
A1 Reena Khanna
A1 Siew C Ng
A1 Julián Panés
A1 Gert van Assche
A1 Zhanju Liu
A1 Ailsa Hart
A1 Barrett G Levesque
A1 Geert D'Haens
YR 2014
UL http://gut.bmj.com/content/63/9/1381.abstract
AB Objective To develop a consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease (pCD), based on best available evidence. Methods Based on a systematic literature review, statements were formed, discussed and approved in multiple rounds by the 20 working group participants. Consensus was defined as at least 80% agreement among voters. Evidence was assessed using the modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Results Highest diagnostic accuracy can only be established if a combination of modalities is used. Drainage of sepsis is always first line therapy before initiating immunosuppressive treatment. Mucosal healing is the goal in the presence of proctitis. Whereas antibiotics and thiopurines have a role as adjunctive treatments in pCD, anti-tumour necrosis factor (anti-TNF) is the current gold standard. The efficacy of infliximab is best documented although adalimumab and certolizumab pegol are moderately effective. Oral tacrolimus could be used in patients failing anti-TNF therapy. Definite surgical repair is only of consideration in the absence of luminal inflammation. Conclusions Based on a multidisciplinary approach, items relevant for fistula management were identified and algorithms on diagnosis and treatment of pCD were developed.