Perianal Crohn's disease: a review

Postgraduate Medicine
Anna C JuncadellaAmar R Deshpande

Abstract

Perianal involvement in Crohn's disease (CD), which encompasses fistulas, ulcers, abscesses, strictures and cancer, can lead to significant impairment in quality of life. The objective of this article is to review the major perianal complications of CD and the current medical and surgical modalities used to treat them. Antibiotics are commonly used despite a lack of controlled trials to validate their use and should be used as a bridge to maintenance therapy. The anti-metabolites azathioprine and 6-MP have shown a positive response in terms of fistula closure, although these data are mostly from trials looking at this as a secondary endpoint. Infliximab is an effective agent for induction and maintenance of treatment of fistulizing CD. Further studies to evaluate the use of subcutaneous anti-tumor necrosis factors are needed to convincingly prove their efficacy for perianal fistulizing disease. In CD, clinicians should avoid surgery as a first-line approach for skin tags, hemorrhoids or fissures in the setting of proctitis. Surgery, particularly lateral internal sphincterotomy, in combination with medical therapy is associated with higher fissure healing rates in the absence of proctitis. Fistulotomy is curative for most simple...Continue Reading

References

Apr 5, 1975·Lancet·B Ursing, C Kamme
Jan 1, 1976·The British Journal of Surgery·A G ParksJ D Hardcastle
Apr 1, 1986·International Journal of Colorectal Disease·M R Keighley, R N Allan
Sep 1, 1971·Gut·J A Williams
May 1, 1980·The New England Journal of Medicine·D H PresentB S Pasternack
Nov 1, 1980·American Journal of Surgery·P BuchmannJ Alexander-Williams
Jan 1, 1981·Diseases of the Colon and Rectum·D R WilliamsM C Veidenheimer
Nov 1, 1995·Diseases of the Colon and Rectum·P R FleshnerM C Veidenheimer
Jul 15, 1995·Annals of Internal Medicine·D C PearsonL R Sutherland
Jun 1, 1993·Diseases of the Colon and Rectum·A F Wolkomir, M A Luchtefeld
Feb 1, 1997·American Journal of Surgery·T L Hull, V W Fazio
Oct 15, 1998·The American Journal of Gastroenterology·K FellermannE F Stange
Jan 6, 1999·The British Journal of Surgery·P MarchesaV W Fazio
May 6, 1999·The New England Journal of Medicine·D H PresentS J van Deventer
Mar 24, 2000·Journal of Clinical Gastroenterology·E IerardiA Francavilla
Oct 3, 2000·Surgery·F MichelassiR D Hurst
Jun 8, 2001·Gastroenterology Clinics of North America·M Jonas, J H Scholefield
Nov 20, 2001·Annals of Internal Medicine·D A SchwartzW J Sandborn
Mar 23, 2002·Gastroenterology·David A SchwartzWilliam J Sandborn
Jan 4, 2003·Gastroenterology·Robert D Madoff, James W Fleshman
Nov 5, 2003·Gastroenterology·UNKNOWN American Gastroenterological Association Clinical Practice Committee
Nov 5, 2003·Gastroenterology·William J SandbornUNKNOWN American Gastroenterological Association Clinical Practice Committee
Dec 5, 2003·Alimentary Pharmacology & Therapeutics·C DejacoW Reinisch
Feb 12, 2004·Alimentary Pharmacology & Therapeutics·H H WenzlW Petritsch
Feb 27, 2004·The New England Journal of Medicine·Bruce E SandsSander J van Deventer
Jul 1, 2004·The British Journal of Surgery·B SinghB George
Aug 19, 2004·European Journal of Gastroenterology & Hepatology·Su Yang SoonJeremy D Sanderson
Oct 12, 2004·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Bruce E SandsUNKNOWN ACCENT II Study
May 27, 2005·The New England Journal of Medicine·Joshua R KorzenikUNKNOWN Sargramostim in Crohn's Disease Study Group
Jun 14, 2005·Alimentary Pharmacology & Therapeutics·V VittonJ C Grimaud
Jul 12, 2005·Techniques in Coloproctology·M T SwinscoeD G Jayne
Aug 15, 2006·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Linda Y TangCharles N Bernstein
Feb 20, 2007·Alimentary Pharmacology & Therapeutics·S PlamondonM A Kamm
Mar 29, 2007·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Cesare RuffoloImerio Angriman
May 2, 2007·Annals of Internal Medicine·William J SandbornPaul F Pollack

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Citations

Apr 25, 2019·Current Gastroenterology Reports·Thomas X Lu, Russell D Cohen
Dec 8, 2020·Journal of Pediatric Surgery·Gillian R GoddardJason S Frischer

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