Review article: The medical treatment of Crohn's perianal fistulas.
Perianal fistulas are a frequent manifestation of Crohn's disease. The correct application of the newer diagnostic and therapeutic agents for treating perianal Crohn's disease are beginning to be better defined. In general, a combined medical and surgical approach is preferred. The perianal disease process should first be fully delineated with endoscopy and either MRI or EUS before treatment is begun. Patients are then stratified into one of three groups: simple fistulas and no proctitis; simple fistulas and concomitant proctitis; and complex fistulas. Patients with simple fistulas and no proctitis can be treated medically with a combination of antibiotics and an immunosuppressive agent (azathioprine or mercaptopurine). Patients with simple fistulas and concomitant proctitis should have infliximab added to their treatment plan. Complex fistulas require surgical intervention first prior to medical treatment. A combination of antibiotics, immunosuppressive therapy and infliximab are then initiated to facilitate fistula healing.
Schwartz
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DA
Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, Vanderbilt University Medical Center, Nashville, TN 37232, USA. David.a.schwartz@vanderbilt.edu
Herdman
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CR
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001004:Anus Diseases / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011349:Proctitis / Q000150:complications; D012003:Rectal Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents