Current and Emerging Treatment Strategies for Perianal Fistulas in Crohn’s Disease

OVERVIEW

Crohn’s disease (CD) is a chronic, progressive disorder characterized by transmural inflammation that can occur anywhere throughout the gastrointestinal (GI) tract. The disease follows an intermittent course and develops from an interplay between genetic, immunologic, and environmental factors. It is estimated that 780,000 Americans have CD. The clinical presentation and disease course can vary greatly among patients, and often depends upon the affected area of the GI tract. In patients with CD, chronic inflammation of the intestines can lead to compromised mucosal integrity and epithelial defects, resulting in the development of fistulas. It has been estimated that fistulas occur in about one-third to one-half of adult patients with CD, and the perianal area is the most common area for fistula development. Complex perianal fistulas, which originate in the upper part of the sphincter complex, connect to other organs such as the vagina or bladder, are associated with an abscess or rectal stricture, or have multiple tracts, account for about 70% to 80% of all perianal fistulas in patients with CD, causing severe pain, swelling, drainage, and fecal incontinence. The development of perianal fistulas is indicative of a more aggressive disease course and is one of the most challenging manifestations of CD to treat.

Multidisciplinary care is essential for the treatment of perianal fistulas in patients with CD, as it has been shown that the combination of medical and surgical treatments currently yields the highest rates of complete closure and lowest rates of recurrence. However, remission and sustained healing is often elusive. After many years with few advances in the treatment of fistulizing CD, a promising new approach involves the use of stem cells. Ongoing research of this novel treatment in the US offer hope for patients that struggle with CD and perianal fistulas. It is important for clinicians to keep up-to-date with the latest treatment information in order to offer the best possible care to their patients.

FACULTY

PROVIDER STATEMENT

Provided by North American Center for Continuing Medical Education, LLC (NACCME), an HMP Company.

For questions regarding this educational activity, please call 609-371-1137 or email info@naccme.com.

INTENDED LEARNERS

Designed and certified for the entire IBD healthcare team and includes education for gastroenterologists, pediatric gastroenterologists, surgeons, physicians, PhDs, researchers, pharmacists, nurse practitioners, physician assistants, gastroenterology nurses, and residents/fellows/students.

LEARNING OBJECTIVES

After participating in this activity, learners should be able to:

• Describe the pathophysiology and morbidity associated with perianal fistulas in CD
• Apply current treatment recommendations for perianal fistulas in patients with CD
• Interpret clinical data on emerging treatments for perianal fistulas in patients with CD

CLAIMING CREDIT

To be eligible for credit, participants must complete the online activity and the evaluation. Upon completing the activity, there will be instructions on how to complete the evaluation and print a certificate or other documentation of credit.

Release Date: January 11, 2022
Expiration Date: January 11, 2023
Estimated Time to Complete: 30 minutes

There is no fee associated with this activity.

EDUCATION GRANT SUPPORT

NACCME would like to thank the following company who has supported this program through an educational grant: Takeda Pharmaceuticals U.S.A., Inc.

CONTINUING EDUCATION

In support of improving patient care, this activity has been planned and implemented by North American Center for Continuing Education (NACCME) and Imedex. NACCME is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

PHYSICIANS

NACCME designates this internet enduring activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

NURSING

This continuing nursing education activity awards 0.50 contact hours.

Provider approved by the California Board of Registered Nursing, Provider #13255 for 0.50 contact hour. 

PHARMACY

This internet enduring, knowledge-based activity (Universal Activity Number: JA0006201-9999-21-136-H01-P) has been approved for a maximum of 0.50 contact hours (.05 CEUs).

The certificate is not the official record of your participation in the activity. The official record of credit will be the information in CPE Monitor system. The deadline to claim credit is 60 days after activity. Following ACPE Policy, NACCME will not be able to report your claimed credit to CPE Monitor after this 60-day period. Eligibility for pharmacy credit is contingent upon the successful completion of a post-test and/or evaluation for each activity or session attended. 

PHYSICIAN ASSISTANTS

NACCME has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 0.50 CME credit for activities planned in accordance with the AAPA CME Criteria. This activity is designated for 0.50 AAPA Category 1 credit(s). PAs should only claim credit commensurate with the extent of their participation.

USE OF PROPRIETARY NAMES

This continuing medical education activity may include device or medicine brand names for participant clarity purposes only, due to the presence of different branded versions of the same product. No product promotion or recommendation should be inferred.

UNAPPROVED AND/OR INVESTIGATIONAL USES OF DRUGS AND DEVICES

This activity may contain information about experimental and other uses of drugs or devices that are not currently approved by the European Medicines Agency (EMA) of the European Union or the Food and Drug Administration (FDA) of the United States. Participants are strongly encouraged to consult approved product labeling for any drug or device mentioned in this activity before use. The opinions expressed during this activity are the opinions of the respective authors, presenters or moderators and do not necessarily reflect the opinions of NACCME.

DISCLAIMERS

The material presented and related discussions are not intended to be medical advice, and the presentation or discussion of such material is not intended to create and does not establish a physician-patient relationship. Medical advice of any nature should be sought from an individual’s own physician.

Neither NACCME nor any of its subsidiaries or affiliates is affiliated with, or formally endorsed by a medical society.

The opinions expressed in this educational activity are those of the faculty and are not attributable to NACCME or HMP. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this activity are not necessarily the same as indicated in the package insert for each product, may reflect the clinical experience of the presenters, and may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS

NACCME, LLC is an independent provider of continuing medical education. NACCME, LLC has no proprietary or financial interest in medical or healthcare products over which the FDA (USA) or EMA (EU) has regulatory authority.

In accordance with our disclosure policies, NACCME is committed to ensuring balance, independence, objectivity, and scientific rigor for all accredited continuing education. These policies include assigning relevance to, and mitigating, all perceived or real conflicts of interest between any individual with control over the content and any ineligible company (commercial interest) as defined by the ACCME.

Any individual with control over accredited content, including planner, faculty, and reviewer, is required to globally disclose:

1. Individual relationship(s) or lack thereof, and its nature, with any/all ineligible company, and;
2. any investigational, off-label, or non-FDA approved content or discussion

NACCME has reviewed these disclosures, assigned relevance based on the relationship and scope of content, and identified those with the potential to compromise the goals and educational integrity of the education. Relevant relationships, or lack thereof, are shared with the learner.

Education has been independently peer-reviewed to validate content, mitigate identified conflicts of interest, and ensure:

1. All recommendations involving clinical medicine is based on evidence that is accepted within the medical profession as adequate justification for their indications and contraindications in the care of patients.
2. All scientific research referred to, reported, or used in accredited continuing education in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection, and analysis.
3. Content is appropriate, fair and balanced, unbiased, referenced, and non-promotional.

FACULTY

The faculty has reported the following:

Amy L. Lightner, MD: Consultant - Takeda

PLANNING COMMITTEE

NACCME and Imedex planners and staff include Samantha Conforti, Damon Harper, Kelly Jackson, Mary Johnson, Randy Robbin, and Greaton Sellers.

No NACCME or Imedex planner or staff has disclosed a relevant financial relationship with any ineligible company (commercial interest).

ADA STATEMENT

North American Center for Continuing Medical Education (NACCME) complies with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please call 609-371-1137.

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NACCME protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. NACCME and our joint sponsors will not release personally identifiable information to a third party without the individual’s consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

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Copyright © 2022 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education.

GRIEVANCE POLICY

Any participant wanting to file a grievance with respect to any aspect of a continuing education activity accredited by NACCME, LLC may contact Samantha Conforti, Manager, Accreditation and Compliance, by phone at 609-371-1137, by email at sconforti@naccme.com or in writing at 104 Windsor Center Drive, East Windsor, NJ 08520. Ms. Conforti will review the grievance and respond within 30 days of receiving the complaint. If the participant is unsatisfied with the response, an appeal to the Associate Director, Greaton Sellers, Accreditation and Compliance, can be requested for a second level of review. Mr. Sellers can be contacted via phone at 609-371-1137, by email at gsellers@naccme.com or in writing at 104 Windsor Center Drive, East Windsor, NJ 08520.