Treatment of fibrostenotic and fistulizing Crohn's disease.
The majority of Crohn's disease patients will develop a complicated disease course over time which is characterized by the occurrence of stricturing and penetrating disease. Penetrating disease comprises internal fistulas (e.g. enteroenteric) and perianal disease. A complicated disease course may be associated with considerable morbidity and professional and personal disabilities. Treatment options for fibrostenotic Crohn's disease comprise endoscopic balloon dilation, stricturoplasties and surgical resection. Treatment of symptomatic perianal fistulizing disease is based on antibiotics, immunomodulators and anti-TNF drugs. Surgical measures include fistula drainage by means of setons, temporary ileostomy or a proctectomy. The presence of internal fistulas often necessitates surgical measures. A close collaboration between the gastroenterologist and the surgeon is mandatory to solve these interdisciplinary challenges.
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Alain.schoepfer @ chuv.ch
Alain M
AM
Schoepfer
Ekaterina
E
Safroneeva
Stephan R
SR
Vavricka
Laurent
L
Peyrin-Biroulet
Christian
C
Mottet
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D004106:Dilatation / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents