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Treatment of Fistulizing Crohn's Disease in Children

Alka Goyal1, Evan P. Nadler, Henri R. Ford

  • 1Departments of Gastroenterology and Surgery, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213-2583, USA. alka.goyal@chp.edu

Current Treatment Options in Gastroenterology
|September 5, 2003
PubMed

Insights

Crohn

Area of Science:

  • Gastroenterology and Surgical Management
  • Pediatric Inflammatory Bowel Disease
  • Fistulizing Crohn's Disease Treatment

Background:

  • Crohn's disease frequently causes fistulae, impacting patient quality of life.
  • Limited prospective studies exist for pediatric Crohn's fistulae therapy.
  • Multidisciplinary assessment involving gastroenterologists, radiologists, and surgeons is crucial.

Purpose of the Study:

  • To review current therapeutic strategies for Crohn's disease fistulae.
  • To highlight evidence gaps, particularly in pediatric populations.
  • To inform clinical decision-making for managing complex fistulizing Crohn's disease.

Main Methods:

  • Review of existing literature on Crohn's fistulae management.
  • Analysis of prospective studies, including double-blinded trials.
  • Evaluation of medical and surgical treatment options.

Main Results:

  • Infliximab shows short-term efficacy in prospective trials.
  • Metronidazole and 6-mercaptopurine/azathioprine have supporting evidence for acute and maintenance therapy, respectively.
  • Corticosteroids may worsen outcomes; diverting ostomies have limited utility.

Conclusions:

  • Management requires integrated medical and surgical approaches.
  • Evidence-based therapies are limited, especially for pediatric Crohn's fistulae.
  • Further high-quality research is needed to optimize treatment strategies.

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