Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn's disease. Issue 7 (13th August 2014)

• Record Type: Journal Article
• Authors: Yassin, N. A.; Askari, A.; Warusavitarne, J.; Faiz, O. D.; Athanasiou, T.; Phillips, R. K. S.; Hart, A. L.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 40:Issue 7(2014)
• Page Start: 741
• Page End: 749
• Publication Date: 2014-08-13
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12906
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12906-abs-0001"> <title>Summary</title> <sec id="apt12906-sec-0001" sec-type="section"> <title>Background</title> <p>The management of perianal Crohn's fistulas represents a significant challenge. A combination of medical and surgical therapy, guided by radiology, is often required.</p> </sec> <sec id="apt12906-sec-0002" sec-type="section"> <title>Aim</title> <p>To review systematically the literature to assess fistula healing rates with medical treatment (anti‐TNF‐α therapies ± immunomodulators) or surgical treatment alone, compared with combined medical and surgical treatment in fistulising perianal Crohn's disease (CD).</p> </sec> <sec id="apt12906-sec-0003" sec-type="section"> <title>Methods</title> <p>The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were used. Two independent reviewers searched the literature.</p> </sec> <sec id="apt12906-sec-0004" sec-type="section"> <title>Results</title> <p>Twenty‐four articles were included. The total population was 1139 patients; 460 (40%) received single treatment with either medical or surgical therapy, and 679 (60%) received combined medical and surgical therapy. Eight studies compared single and combination therapy, with a total population of 797 patients (single therapy: <italic>n</italic> = 448, combination therapy: <italic>n</italic> = 349). In the single therapy group, 191/448 were in complete remission (43%). This was lower than the healing rate of the combination therapy group 180/349 (52%). No response to therapy was noted in 34% (153/448) of the single therapy group compared with 23% (80/349) of the combination group.</p> </sec> <sec id="apt12906-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Combined surgical and medical (anti‐TNF‐α ± immunomodulators) therapy may have additional beneficial effects on perianal fistula healing in patients with Crohn's disease, compared with surgery or medical therapy alone. A well‐designed Crohn's perianal fistula clinical trial is required in a multidisciplinary medical and surgical setting, with clearly defined end points of clinical (and likely patient reported outcomes) and radiological healing.</p> </sec> </abstract>