Diagnosis and management of fistulizing Crohn's disease

Nature Clinical Practice Gastroenterology and Hepatology

Volumn 6, Issue 2, 2009, Pages 92-106

  Nielsen, Ole Haagen ^a   Rogler, Gerhard ^b   Hahnloser, Dieter ^b   Thomsen, Ole Østergaard ^a  

^a UNIVERSITY OF COPENHAGEN   (Denmark)

^b UNIVERSITY HOSPITAL ZURICH   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

ADALIMUMAB; ANTIBIOTIC AGENT; AZATHIOPRINE; BARIUM; CALCINEURIN INHIBITOR; CARBON; CERTOLIZUMAB PEGOL; CIPROFLOXACIN; CYCLOSPORIN; FOLIC ACID; GLUCOCORTICOID; INFLIXIMAB; MERCAPTOPURINE; MESALAZINE; METHOTREXATE; METRONIDAZOLE; PLACEBO; PREDNISOLONE; RECOMBINANT GRANULOCYTE MACROPHAGE COLONY STIMULATING FACTOR; TACROLIMUS;

ABSCESS; ANUS FISTULA; ANUS SURGERY; CLINICAL ASSESSMENT TOOL; CLINICAL TRIAL; COMPUTER ASSISTED TOMOGRAPHY; CONTRAST ENHANCEMENT; CROHN DISEASE; CROHN DISEASE ACTIVITY INDEX; DIAGNOSTIC ACCURACY; DISEASE ACTIVITY; DRUG DOSE INCREASE; DRUG DOSE REDUCTION; DRUG DOSE TITRATION; DRUG MEGADOSE; ECHOGRAPHY; ENTEROENTERAL FISTULA; FISTULA; GASTROINTESTINAL SURGERY; HUMAN; INCIDENCE; INTESTINE FISTULA; LAPAROSCOPY; MONOTHERAPY; NUCLEAR MAGNETIC RESONANCE IMAGING; PATHOGENESIS; PLACEBO EFFECT; PREVALENCE; PRIORITY JOURNAL; RECTOVAGINAL FISTULA; REVIEW; SCORING SYSTEM; T CELL LYMPHOMA; UNSPECIFIED SIDE EFFECT; WOUND HEALING;

CROHN DISEASE; HUMANS; INTESTINAL FISTULA; RECTAL FISTULA; SEVERITY OF ILLNESS INDEX; TREATMENT OUTCOME;

EID: 59949105756     PISSN: 17434378     EISSN: 17434386     Source Type: Journal    
DOI: 10.1038/ncpgasthep1340     Document Type: Review

References (115)

1. Judge TA and Lichtenstein GR (2004) Treatment of fistulizing Crohn's disease. Gastroenterol Clin North Am 33: 421-454
2. Hellers G et al. (1980) Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 21: 525-527
3. Schwartz DA et al. (2002) The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 122: 875-880
4. Solomon MJ (1996) Fistulae and abscesses in symptomatic perianal Crohn's disease. Int J Colorectal Dis 11: 222-226
5. Sandborn WJ et al. (2003) Tacrolimus for the treatment of fistulas in patients with Crohn's disease: A randomized, placebo-controlled trial. Gastroenterology 125: 380-388
6. American Gastroenterological Association Clinical Practice Committee (2003) American Gastroenterological Association medical position statement: Perianal Crohn's disease. Gastroenterology 125: 1503-1507
7. Williamson PR et al. (1995) Twenty-year review of the surgical management of perianal Crohn's disease. Dis Colon Rectum 38: 389-392
8. Ky AJ et al. (2008) Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum 51: 838-843
9. Schwartz DA et al. (2001) A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. Gastroenterology 121: 1064-1072
10. Kuijpers HC and Schulpen T (1985) Fistulography for fistula-in-ano. Is it useful? Dis Colon Rectum 28: 103-104
11. West RL et al. (2005) Perianal fistulas in Crohn's disease are predominantly colonized by skin flora: Implications for antibiotic treatment? Dig Dis Sci 50: 1260-1263
12. Bataille F et al. (2004) Morphological characterisation of Crohn's disease fistulae. Gut 53: 1314-1321
13. Leeb SN et al. (2003) Reduced migration of fibroblasts in inflammatory bowel disease: Role of inflammatory mediators and focal adhesion kinase. Gastroenterology 125: 1341-1354
14. Leeb SN et al. (2004) Autocrine fibronectin-induced migration of human colonic fibroblasts. Am J Gastroenterol 99: 335-340
15. Dignass AU (2001) Mechanisms and modulation of intestinal epithelial repair. Inflamm Bowel Dis 7: 68-77
16. Goke M et al. (1996) Regulation and function of extracellular matrix intestinal epithelial restitution in vitro. Am J Physiol 271: G729-G740
17. Podolsky DK (1997) Healing the epithelium: Solving the problem from two sides. J Gastroenterol 32: 122-126
18. Tarnawski AS (2005) Cellular and molecular mechanisms of gastrointestinal ulcer healing. Dig Dis Sci 50 (suppl 1): S24-S33
19. Kalluri R and Neilson EG (2003) Epithelialmesenchymal transition and its implications for fibrosis. J Clin Invest 112: 1776-1784
20. Lee JM et al. (2006) The epithelial-mesenchymal transition: New insights in signaling, development, and disease. J Cell Biol 172: 973-981
21. Arias AM (2001) Epithelial mesenchymal interactions in cancer and development. Cell 105: 425-431
22. Thiery JP (2003) Epithelial-mesenchymal transitions in development and pathologies. Curr Opin Cell Biol 15: 740-746
23. Irvine EJ (1995) Usual therapy improves perianal Crohn's disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol 20: 27-32
24. Present DH et al. (1999) Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 340: 1398-1405
25. Sandborn WJ et al. (2002) A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn's disease. Gastroenterology 122: 512-530
26. Best WR et al. (1976) Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology 70: 439-444
27. Present DH et al. (1980) Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med 302: 981-987
28. Dejaco C et al. (2003) Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease. Aliment Pharmacol Ther 18: 1113-1120
29. Ardizzone S et al. (2004) Perianal fistulae following infliximab treatment: Clinical and endosonographic outcome. Inflamm Bowel Dis 10: 91-96
30. Sands BE et al. (2004) Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 350: 876-885
31. Nielsen OH and Munck LK (2007) Drug insight: Aminosalicylates for the treatment of IBD. Nat Clin Pract Gastroenterol Hepatol 4: 160-170
32. Jones JH and Lennard-Jones JE (1966) Corticosteroids and corticotrophin in the treatment of Crohn's disease. Gut 7: 181-187
33. Sparberg M and Kirsner JB (1966) Long-term corticosteroid therapy for regional enteritis: An analysis of 58 courses in 54 patients. Am J Dig Dis 11: 865-880
34. Malchow H et al. (1984) European Cooperative Crohn's Disease Study (ECCDS): Results of drug treatment. Gastroenterology 86: 249-266
35. Brandt LJ et al. (1982) Metronidazole therapy for perineal Crohn's disease: A follow-up study. Gastroenterology 83: 383-387
36. Jakobovits J and Schuster MM (1984) Metronidazole therapy for Crohn's disease and associated fistulae. Am J Gastroenterol 79: 533-540
37. Schneider MU et al. (1985) Metronidazole in the treatment of Crohn disease. Results of a controlled randomized prospective study [German]. Dtsch Med Wochenschr 110: 1724-1730
38. Bernstein LH et al. (1980) Healing of perineal Crohn's disease with metronidazole. Gastroenterology 79: 357-365
39. Prantera C et al. (1998) Use of antibiotics in the treatment of active Crohn's disease: Experience with metronidazole and ciprofloxacin. Ital J Gastroenterol Hepatol 30: 602-606
40. Turunen U et al. (1993) Long-term outcome of ciprofloxacin treatment in severe perianal or fistulous Crohn's disease [abstract]. Gastroenterology 104: A793
41. West RL et al. (2004) Clinical and endosonographic effect of ciprofloxacin on the treatment of perianal fistulae in Crohn's disease with infliximab: A doubleblind placebo-controlled study. Aliment Pharmacol Ther 20: 1329-1336
42. Nielsen OH et al. (2001) Review article: The treatment of inflammatory bowel disease with 6-mercaptopurine or azathioprine. Aliment Pharmacol Ther 15: 1699-1708
43. Korelitz BI and Present DH (1985) Favorable effect of 6-mercaptopurine on fistulae of Crohn's disease. Dig Dis Sci 30: 58-64
44. O'Brien JJ et al. (1991) Use of azathioprine or 6-mercaptopurine in the treatment of Crohn's disease. Gastroenterology 101: 39-46
45. Pearson DC et al. (1995) Azathioprine and 6-mercaptopurine in Crohn disease. A metaanalysis. Ann Intern Med 123: 132-142
46. Wheeler SC et al. (1998) Medical therapy, not surgery is the appropriate first line of treatment for Crohn's enterovesical fistula. Gastroenterology 114: A1113
47. Margolin ML and Korelitz BI (1989) Management of bladder fistulas in Crohn's disease. J Clin Gastroenterol 11: 399-402
48. Greenstein AJ et al. (1989) Gastric fistulas in Crohn's disease. Report of cases. Dis Colon Rectum 32: 888-892
49. Korelitz BI et al. (1993) Long-term experience with 6-mercaptopurine in the treatment of Crohn's disease. Am J Gastroenterol 88: 1198-1205
50. Cuffari C et al. (2001) Utilisation of erythrocyte 6-thioguanine metabolite levels to optimise azathioprine therapy in patients with inflammatory bowel disease. Gut 48: 642-646
51. Egan LJ et al. (1998) Clinical outcome following treatment of refractory inflammatory and fistulizing Crohn's disease with intravenous cyclosporine. Am J Gastroenterol 93: 442-448
52. Hanauer SB and Smith MB (1993) Rapid closure of Crohn's disease fistulas with continuous intravenous cyclosporin A. Am J Gastroenterol 88: 646-649
53. Present DH and Lichtiger S (1994) Efficacy of cyclosporine in treatment of fistula of Crohn's disease. Dig Dis Sci 39: 374-380
54. Gurudu SR et al. (1999) Cyclosporine therapy in inflammatory bowel disease: Short-term and longterm results. J Clin Gastroenterol 29: 151-154
55. McDonald JW et al. Cyclosporine for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD000297
56. Plosker GL and Foster RH (2000) Tacrolimus: A further update of its pharmacology and therapeutic use in the management of organ transplantation. Drugs 59: 323-389
57. van Dullemen HM et al. (1995) Treatment of Crohn's disease with anti-tumor necrosis factor chimeric monoclonal antibody (cA2). Gastroenterology 109: 129-135
58. Peyrin-Biroulet L et al. (2008) Crohn's disease: Beyond antagonists of tumour necrosis factor. Lancet 372: 67-81
59. Sands BE et al. (2004) Long-term treatment of rectovaginal fistulas in Crohn's disease: Response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol 2: 912-920
60. Lichtenstein GR et al. (2005) Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn's disease. Gastroenterology 128: 862-869
61. Theis VS and Rhodes JM (2008) Review article: Minimizing tuberculosis during anti-tumour necrosis factor-alpha treatment of inflammatory bowel disease. Aliment Pharmacol Ther 27: 19-30
62. Hanauer SB et al. (2006) Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: The CLASSIC-I trial. Gastroenterology 130: 323-333
63. Sandborn WJ et al. (2007) Adalimumab induction therapy for Crohn disease previously treated with infliximab: A randomized trial. Ann Intern Med 146: 829-838
64. Colombel JF et al. (2007) Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: The CHARM trial. Gastroenterology 132: 52-65
65. Baumgart DC and Sandborn WJ (2007) Inflammatory bowel disease: Clinical aspects and established and evolving therapies. Lancet 369: 1641-1657
66. Sandborn WJ et al. (2007) Certolizumab pegol for the treatment of Crohn's disease. N Engl J Med 357: 228-238
67. Schreiber S et al. (2007) Maintenance therapy with certolizumab pegol for Crohn's disease. N Engl J Med 357: 239-250
68. Clark M et al. (2007) American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23, 2006. Gastroenterology 133: 312-339
69. Bongartz T et al. (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295: 2275-2285
70. Askling J et al. (2005) Haematopoietic malignancies in rheumatoid arthritis: Lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists. Ann Rheum Dis 64: 1414-1420
71. Lichtenstein GR et al. (2007) Safety of infliximab and other Crohn's disease therapies - Treat Registry. Data with nearly 20,000 patient-years of follow-up [abstract]. Gastroenterology 132: A178
72. Sands BE et al. (2006) Maintenance infliximab does not result in increased abscess development in fistulizing Crohn's disease: Results from the ACCENT II study. Aliment Pharmacol Ther 23: 1127-1136
73. Baert F et al. (2003) Influence of immunogenicity on the long-term efficacy of infliximab in Crohn's disease. N Engl J Med 348: 601-608
74. Fefferman DS and Farrell RJ (2005) Immunogenicity of biological agents in inflammatory bowel disease. Inflamm Bowel Dis 11: 497-503
75. van der Woude CJ and Hommes DW (2007) Biologics in Crohn's disease: searching indicators for outcome. Expert Opin Biol Ther 7: 1233-1243
76. Mackey AC et al. (2007) Hepatosplenic T cell lymphoma associated with infliximab use in young patients treated for inflammatory bowel disease. J Pediatr Gastroenterol Nutr 44: 265-267
77. Veres G et al. (2007) Infliximab therapy in children and adolescents with inflammatory bowel disease. Drugs 67: 1703-1723
78. Hanauer SB (2007) Risks and benefits of combining immunosuppressives and biological agents in inflammatory bowel disease: Is the synergy worth the risk? Gut 56: 1181-1183
79. Korzenik JR et al. (2005) Sargramostim for active Crohn's disease. N Engl J Med 352: 2193-2201
80. Mahadevan U et al. (2003) Fistula response to methotrexate in Crohn's disease: A case series. Aliment Pharmacol Ther 18: 1003-1008
81. Soon SY et al. (2004) Experience with the use of lowdose methotrexate for inflammatory bowel disease. Eur J Gastroenterol Hepatol 16: 921-926
82. Feagan BG et al. (1995) Methotrexate for the treatment of Crohn's disease. The North American Crohn's Study Group Investigators. N Engl J Med 332: 292-297
83. Fukuda Y et al. (2008) Oral spherical adsorptive carbon for the treatment of intractable anal fistulas in Crohn's disease: A multicenter, randomized, doubleblind, placebo-controlled trial. Am J Gastroenterol 103: 1721-1729
84. Fichera A and Michelassi F (2007) Surgical treatment of Crohn's disease. J Gastrointest Surg 11: 791-803
85. Williams JG et al. (2007) The treatment of anal fistula: ACPGBI position statement. Colorectal Dis 9 (suppl 4): 18-50
86. Sangwan YP et al. (1996) Perianal Crohn's disease. Results of local surgical treatment. Dis Colon Rectum 39: 529-535
87. Levien DH et al. (1989) Surgical treatment of anorectal fistula in patients with Crohn's disease. Surg Gynecol Obstet 169: 133-136
88. Williams JG et al. (1991) Fistula-in-ano in Crohn's disease. Results of aggressive surgical treatment. Dis Colon Rectum 34 378-384
89. Buchanan GN et al. (2004) Long-term outcome following loose-seton technique for external sphincter preservation in complex anal fistula. Br J Surg 91: 476-480
90. Makowiec F et al. (1995) Clinical course of perianal fistulas in Crohn's disease. Gut 37: 696-701
91. Hyman N (1999) Endoanal advancement flap repair for complex anorectal fistulas. Am J Surg 178: 337-340
92. Vasilevsky CA and Gordon PH (1984) The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27: 126-130
93. Joo JS et al. (1998) Endorectal advancement flap in perianal Crohn's disease. Am Surg 64: 147-150
94. Jones IT et al. (1987) The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum. Dis Colon Rectum 30: 919-923
95. Mizrahi N et al. (2002) Endorectal advancement flap: Are there predictors of failure? Dis Colon Rectum 45: 1616-1621
96. Mueller MH et al. (2007) Risk of fecal diversion in complicated perianal Crohn's disease. J Gastrointest Surg 11: 529-537
97. Galandiuk S et al. (2005) Perianal Crohn disease: Predictors of need for permanent diversion. Ann Surg 241: 796-801
98. Johnson EK et al. (2006) Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum 49: 371-376
99. Committee Consensus Statement (2008) The Surgisis® AFP™ anal fistula plug: Report of a consensus conference. Colorectal Dis 10: 17-20
100. Schwandner O et al. (2008) Initial experience on efficacy in closure of cryptoglandular and Crohn's transsphincteric fistulas by the use of the anal fistula plug. Int J Colorectal Dis 23: 319-324
101. O'Connor L et al. (2006) Efficacy of anal fistula plug in closure of Crohn's anorectal fistulas. Dis Colon Rectum 49: 1569-1573
102. Loungnarath R et al. (2004) Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum 47: 432-436
103. Williamson PR et al. (1995) Twenty-year review of the surgical management of perianal Crohn's disease. Dis Colon Rectum 38: 389-392
104. Yamamoto T et al. (1999) Persistent perineal sinus after proctocolectomy for Crohn's disease. Dis Colon Rectum 42: 96-101
105. Collie MH et al. (2005) Myocutaneous flaps promote perineal healing in inflammatory bowel disease. Br J Surg 92: 740-741
106. Rius J et al. (2000) Gracilis transposition in complicated perianal fistula and unhealed perineal wounds in Crohn's disease. Eur J Surg 166: 218-222
107. Singh B et al. (2004) Perianal Crohn's disease. Br J Surg 91: 801-814
108. Bauer JJ et al. (1991) Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease. Ann Surg 213: 151-158
109. Songne K et al. (2007) Treatment of anovaginal or rectovaginal fistulas with modified Martius graft. Colorectal Dis 9: 653-656
110. Sagar PM et al. (1996) Long-term results of ileal pouch-anal anastomosis in patients with Crohn's disease. Dis Colon Rectum 39: 893-898
111. Zmora O et al. (2001) Reoperative abdominal and perineal surgery in ileoanal pouch patients. Dis Colon Rectum 44: 1310-1314
112. Regan JP and Salky BA (2004) Laparoscopic treatment of enteric fistulas. Surg Endosc 18: 252-254
113. D'Haens G et al. (2008) Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: An open randomised trial. Lancet 371: 660-667
114. da Luz MA et al. (2007) Laparoscopic surgery for patients with Crohn's colitis: A case-matched study. J Gastrointest Surg 11 1529-1533
115. Fichera A et al. (2007) Laparoscopy or conventional open surgery for patients with ileocolonic Crohn's disease? A prospective study. Surgery 142: 566-571