Perianal Crohn's disease: a review.

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Perianal manifestations in Crohn's disease (CD) include fistulas, ulcers, abscesses, strictures, and cancer, severely affecting patient quality of life.
• Effective management strategies for these complications are crucial for improving patient outcomes.

Purpose of the Study:

• To review the primary perianal complications associated with Crohn's disease.
• To discuss current medical and surgical treatment modalities for these conditions.

Main Methods:

• Literature review of medical and surgical treatments for perianal Crohn's disease.
• Analysis of evidence for antibiotics, anti-metabolites (azathioprine, 6-MP), and anti-tumor necrosis factor (TNF) agents.
• Evaluation of surgical interventions including sphincterotomy and sphincter-sparing procedures.

Main Results:

• Antibiotics are commonly used but lack strong trial evidence, serving as a bridge to maintenance therapy.
• Anti-metabolites show positive fistula closure rates, often as secondary endpoints.
• Infliximab is effective for induction and maintenance of fistulizing CD; subcutaneous anti-TNF agents require further study.
• Surgery is not a first-line approach for proctitis-related issues but aids fissure healing without proctitis.
• Fistulotomy is effective for simple fistulas; complex cases necessitate sphincter-sparing surgery. Less invasive methods should be tried first.

Conclusions:

• Treatment of perianal Crohn's disease requires a multimodal approach, balancing medical and surgical options.
• Biologic therapies, particularly infliximab, are key for fistulizing disease.
• Surgical interventions should be tailored to fistula complexity, prioritizing less invasive methods and sphincter preservation where possible.