Long-term outcomes in perianal fistulizing Crohn's disease in a resource-limited setting: A cohort analysis.
Adolescent
Adult
Anti-Bacterial Agents
/ therapeutic use
Biological Products
/ therapeutic use
Crohn Disease
/ complications
Digestive System Surgical Procedures
Female
Follow-Up Studies
Humans
Immunologic Factors
/ therapeutic use
Male
Prospective Studies
Rectal Fistula
/ etiology
Recurrence
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Adalumimab
Anti-TNF
Azathioprine
Biologicals
Biosimilars
Fistulectomy
Immunomodulators
Inflammatory bowel disease
Infliximab
Perianal fistula
Journal
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology
ISSN: 0975-0711
Titre abrégé: Indian J Gastroenterol
Pays: India
ID NLM: 8409436
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
01
04
2020
accepted:
12
05
2020
pubmed:
12
10
2020
medline:
14
9
2021
entrez:
11
10
2020
Statut:
ppublish
Résumé
Perianal fistula is one of the most challenging complications of Crohn's disease (CD). We aimed to describe treatment response with surgical and medical therapies, and long-term complications. We retrospectively analyzed records of patients with perianal fistulizing CD who were prospectively followed from January 2005 to December 2018. Among 807 patients, 81 (10%) had perianal fistula and 65 were included in the final analysis. The mean age of presentation was 27.4 ± 10.3 years, and 78.5% were males with a median duration of follow-up of 45 (IQR, 24-66) months. 75.4% (n = 49) had complex fistulae. 55.4% (n = 36) of patients received multiple courses (> 5 courses) of antibiotics. Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively. The relapse rate was highest after fistula surgery (52.6%). 44.6% of patients received medical (immunomodulators-21 and biologicals-8) whereas 46.1% received surgery as the first-line therapy. The absence of perianal abscess was associated with complete fistula closure. One patient developed malignancy and 4 (6.1%) died at the end of follow-up. Among the patients (n = 28) who received biologicals, TB reactivation occurred in one patient (3.5%). Medical therapy should be offered as first-line therapy, and immunomodulators can be considered when patients cannot afford biologicals. Surgery offers temporary improvement and is associated with high relapse rates. Absence of perianal abscess predicts long-term complete fistula closure.
Sections du résumé
BACKGROUND
BACKGROUND
Perianal fistula is one of the most challenging complications of Crohn's disease (CD). We aimed to describe treatment response with surgical and medical therapies, and long-term complications.
METHODS
METHODS
We retrospectively analyzed records of patients with perianal fistulizing CD who were prospectively followed from January 2005 to December 2018.
RESULTS
RESULTS
Among 807 patients, 81 (10%) had perianal fistula and 65 were included in the final analysis. The mean age of presentation was 27.4 ± 10.3 years, and 78.5% were males with a median duration of follow-up of 45 (IQR, 24-66) months. 75.4% (n = 49) had complex fistulae. 55.4% (n = 36) of patients received multiple courses (> 5 courses) of antibiotics. Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively. The relapse rate was highest after fistula surgery (52.6%). 44.6% of patients received medical (immunomodulators-21 and biologicals-8) whereas 46.1% received surgery as the first-line therapy. The absence of perianal abscess was associated with complete fistula closure. One patient developed malignancy and 4 (6.1%) died at the end of follow-up. Among the patients (n = 28) who received biologicals, TB reactivation occurred in one patient (3.5%).
CONCLUSION
CONCLUSIONS
Medical therapy should be offered as first-line therapy, and immunomodulators can be considered when patients cannot afford biologicals. Surgery offers temporary improvement and is associated with high relapse rates. Absence of perianal abscess predicts long-term complete fistula closure.
Identifiants
pubmed: 33040321
doi: 10.1007/s12664-020-01054-7
pii: 10.1007/s12664-020-01054-7
doi:
Substances chimiques
Anti-Bacterial Agents
0
Biological Products
0
Immunologic Factors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
435-444Références
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