Managing perianal Crohn's fistula in the anti-TNFα era.
Perianal fistulas in Crohn's disease are common and difficult to treat. Their aetiology is poorly understood. Assessment is clinical, endoscopic and radiological, and management is undertaken by a multidisciplinary team of gastroenterologists, surgeons and radiologists. Surgical drainage of the fistula tract system with the placement of loose setons precedes combined therapy with immunosuppressant and anti-TNFα agents in most patients. Proctitis should be rigorously eliminated where possible. Definitive surgical repair is sometimes possible and diversion or proctectomy are occasionally required. Combined medical and surgical management represents a promising avenue for the future.
Fistula Research Unit, St Mark's Hospital, Imperial College London, London, UK. philtozer@doctors.org.uk.
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P
Tozer
University Hospital North Tees, Stockton on Tees, Cleveland, UK.
D W
DW
Borowski
Fistula Research Unit, St Mark's Hospital, Imperial College London, London, UK.
A
A
Gupta
Fistula Research Unit, St Mark's Hospital, Imperial College London, London, UK.
N
N
Yassin
Fistula Research Unit, St Mark's Hospital, Imperial College London, London, UK.
R
R
Phillips
Fistula Research Unit, St Mark's Hospital, Imperial College London, London, UK.
A
A
Hart
D000068879:Adalimumab / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000068582:Certolizumab Pegol / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D003424:Crohn Disease / Q000150:complications*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D010348:Patient Care Team; D012003:Rectal Fistula / Q000145:classification / Q000209:etiology / Q000628:therapy*; D012074:Remission Induction / Q000379:methods; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol
Anti-tumour necrosis factor-α; Biological therapies; Crohn’s disease; Perianal fistula; Surgery