Management of Perianal Crohn's Disease - AJG.

Abstract

Perianal Crohn's disease affects 25-35% of Crohn's disease patients and has proven to be one of the most difficult complications of the disease to treat. Patients with perianal Crohn's disease have lower health related quality of life scores typically related to pain and fecal incontinence. Additionally, perianal Crohn's patients have higher rates of hospitalizations, surgeries and overall healthcare costs. A multidisciplinary approach is necessary for the successful management of Crohn's disease with perianal fistula. Medical management is required to treat the underlying immune dysregulation to heal the luminal inflammation as well as the inflammation within the fistula tracts. Current options for medical therapy include biologics, dual therapy with thiopurines, therapeutic drug monitoring and close follow-up. Surgical management is critical to drain abscesses prior to immunosuppressive therapy and place setons when appropriate. Once the patient's inflammatory burden is well managed, definitive surgical therapies including fistulotomies, advancement flaps and ligation of intersphincteric fistula tract procedures can be considered. Most recently, the use of stem cell therapy in the treatment of perianal fistula has given new hope to the cure of perianal fistula in Crohn's disease. This review will outline the most current data in the medical and surgical management of perianal Crohn's disease.