PGI30 - POLISH THERAPEUTIC ALGORITHMS IN PATIENTS WITH COMPLEX PERIANAL FISTULAS IN CROHN'S DISEASE

Abstract

Complex perianal fistula (CPF) is a chronic and relapsing disease representing a serious therapeutic challenge for both gastroenterologists and surgeons. Main reason for that is lack of any standardized treatment approach for about 12-14% of young patients with Crohn’s disease (CD) who are affected by CPF. The aim of this study was to assess current therapeutic approach for the treatment of CPF in Poland. The study was held from February to April 2018. It consisted of two parts: direct interviews with physicians (30 gastroenterologists and 15 surgeons) and medical records analysis including 75 patients with CPF who failed to respond to standard therapy. The management of patients with CPF significantly differs depending on the experience of a medical center. The role of surgeon was differently perceived depending on the size and experience of the medical center, however the main approach was that gastroenterologists as physicians treating the underlying disease continue pharmacological treatment solely, whereas the surgeon is basically involved in treating complications specific to CPF that require surgical intervention. Among the analyzed 75 patients, in 41% pharmacological treatment solely was applied, whereas in 59% both pharmacological and surgical treatment was applied. The length of pharmacological therapy from the start to the decision to use the next line of treatment was 3 to 24 months. The time from the start of standard CPF treatment to the decision about surgical treatment was 10 to 18 weeks (only patients with surgical treatment analyzed) depending on the experience of the center. The study showed the lack of coordinated care of CPF patients in Poland, relevant differences in treatment patterns depending on the experience of the centers among medical centers and the necessity for extending the range and for improving collaboration between gastroenterologists and surgeons.