Emerging treatments for complex perianal fistula in Crohn's disease.
Complex perianal fistulas have a negative impact on the quality of life of sufferers and should be treated. Correct diagnosis, characterization and classification of the fistulas are essential to optimize treatment. Nevertheless, in the case of patients whose fistulas are associated with Crohn's disease, complete closure is particularly difficult to achieve. Systemic medical treatments (antibiotics, thiopurines and other immunomodulatory agents, and, more recently, anti-tumor necrosis factor-alpha agents such as infliximab) have been tried with varying degrees of success. Combined medical (including infliximab) and less aggressive surgical therapy (drainage and seton placement) offer the best outcomes in complex Crohn's fistulas while more aggressive surgical procedures such as fistulotomy or fistulectomy may increase the risk of incontinence. This review will focus on emerging novel treatments for perianal disease in Crohn's patients. These include locally applied infliximab or tacrolimus, fistula plugs, instillation of fibrin glue and the use of adult expanded adipose-derived stem cell injection. More well-designed controlled studies are required to confirm the effectiveness of these emerging treatments.
Taxonera
Carlos
C
Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico, Madrid 28040, Spain. ctaxonera.hcsc@salud.madrid.org
Schwartz
David A
DA
García-Olmo
Damián
D
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015122:Mercaptopurine / Q000627:therapeutic use; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D015122:Mercaptopurine; D001379:Azathioprine