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Related Experiment Videos

Sarra Ben Azouz1, Nour Elleuch1, Wafa Dahmeni1

  • 1Department of gastroenterology, Sahloul Hospital, Sousse, Tunisia.

La Tunisie Medicale
|May 15, 2024
PubMed
Summary

Managing complex anal fistulas in Crohn's disease after Infliximab failure is challenging. Emerging therapies like Ustekinumab and stem cell injections show promise, alongside surgical options with varying efficacy.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Immunology

Background:

  • Complex perianal fistulas in Crohn's disease present significant treatment challenges, particularly when initial therapy with Infliximab fails.
  • Loss of response to Infliximab, despite its status as a primary treatment, necessitates exploration of alternative therapeutic avenues.

Purpose of the Study:

  • To provide an updated overview of therapeutic alternatives for anal fistulas in Crohn's disease patients who have not responded to Infliximab.
  • To evaluate the efficacy and safety of novel medical and surgical strategies for refractory anal fistulas.

Main Methods:

  • A comprehensive literature search was conducted on PubMed and Google Scholar.
  • Included study types comprised cohort studies, reviews, and randomized double-blinded therapeutic trials.
Keywords:
Anoperineal Crohn’s diseaseInfliximabfailurefistulatreatment

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  • Excluded were case reports and fundamental research studies to focus on clinical evidence.

    • Main Results:

    • While anti-tumor necrosis factor (TNF) therapy, including Infliximab, is a first-line option, its efficacy is around 60% with notable loss-of-response rates.
    • Ustekinumab demonstrates potential efficacy post-anti-TNF failure, though further research is warranted.
    • Mesenchymal stem cell injections are recognized as a safe and effective treatment for complex fistulas according to recent guidelines.
    • Conventional surgical techniques like advancement flaps, fibrin glue, fistula plugs, and fistula tract ligation have shown limited and debated efficacy.

    Conclusions:

    • Anal fistulas in Crohn's disease represent a persistent therapeutic challenge.
    • Ongoing evaluation of new medical and surgical therapies offers encouraging prospects for improved patient management.