Interdisciplinary Management of Perianal Crohn's Disease

Gastroenterol Clin North Am. 2017 Sep;46(3):547-562. doi: 10.1016/j.gtc.2017.05.008.

Abstract

Perianal disease is a common manifestation of Crohn disease (CD) that results in significant morbidity and decreased quality of life. Despite several medical and surgical options, complex perianal CD remains difficult to treat. Before the advent of biologic therapy, antibiotics were the mainstay of medical treatment. Infliximab remains the most well-studied medical therapy for perianal disease. Surgical interventions are limited by the risk of nonhealing wounds and potential incontinence. When treatment options fail, fecal diversion or proctectomy may be necessary. Stem cell therapies may offer improved results and seem to be safe, but are not yet widely used.

Keywords: Combined medical and surgical management; Crohn's disease; Perianal fistulizing disease.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Biological Factors / therapeutic use*
  • Crohn Disease / complications
  • Crohn Disease / diagnostic imaging
  • Crohn Disease / therapy*
  • Digestive System Surgical Procedures
  • Disease Management
  • Drainage / methods*
  • Gastroenterologists
  • Humans
  • Magnetic Resonance Imaging
  • Patient Care Team*
  • Radiologists
  • Rectal Fistula / etiology
  • Rectal Fistula / therapy*
  • Rectum / surgery
  • Surgeons

Substances

  • Anti-Bacterial Agents
  • Biological Factors