Current and Emerging Treatment Strategies for Perianal Fistulas in Crohn’s Disease
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.
Amy L. Lightner, MD
Cleveland Clinic Foundation
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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.
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
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
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