Perianal Disease Activity Index Research Articles

Validity of the EQ-5D-5L and EQ-5D-3L in patients with Crohn's disease.

The EuroQol five-dimension questionnaire (EQ-5D) is the most commonly used instrument to obtain utility values for cost-effectiveness analyses of treatments for Crohn's disease (CD). We aimed to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with CD. Between 2016 and 2017, a multicentre cross-sectional survey was carried out. Consecutive outpatients with CD completed the 3L, 5L and EQ visual analogue scale (VAS). Disease severity was graded by the Crohn's Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). The 3L and 5L were compared in terms of feasibility, agreement, ceiling effect, redistribution properties, discriminatory power, convergent and known-groups validity. Two-hundred and six patients (54.9% male, mean age 35 ± 11years) participated in the survey. For 3L, 25 unique health states were observed versus 59 for the 5L. The overall ceiling effect decreased from 29.6% (3L) to 25.5% (5L). Absolute discriminatory power improved (mean Shannon index 0.84 vs. 1.18). The 3L correlated stronger with EQ VAS and CDAI scores, whereas the 5L with PDAI. The 5L demonstrated a better known-groups validity on the basis of age, perianal fistulas, extraintestinal manifestations and disability. This is the first study to report the impact of CD on quality of life using the EQ-5D-5L questionnaire. The 5L seems to perform better than 3L in terms of feasibility, ceiling effect, discriminatory power and known-groups validity. Understanding the differences in psychometrics between the 3L and 5L is essential as they have substantial implications for financial decision-making about CD treatments.

Sa1756 - Patient-Reported Improvements in Pain and Discharge on the Perianal Disease Activity Index Correlate with Objective Assessments of Perianal Fistula Remission in Patients with Crohn's Disease

Sa1756 - Patient-Reported Improvements in Pain and Discharge on the Perianal Disease Activity Index Correlate with Objective Assessments of Perianal Fistula Remission in Patients with Crohn's Disease

Stem Cell Therapy in Refractory Perineal Crohn's Disease: Long-term Follow-up.

To describe the long-term outcomes of adipose-mesenchymal stem cells, platelet-rich plasma, and endorectal advancement flaps in patients with Perineal Crohn's Disease. This was a single-center, prospective, observational pilot study performed between March 2013 and December 2016. The study included adult patients diagnosed with Perianal Crohn's Disease (with complex perianal fistulas) refractory to previous surgical and/or biological treatment. Patients underwent surgical treatment in two stages. Stage 1: Fistula mapping, drainage, seton placement and lipoaspiration to obtain adipose-mesenchymal stem cells were performed. Stage 2: The setons were removed, and the fistula tract was debrided. A small endorectal advancement flap was created, with closure of the previous internal fistula opening. Then, 100-120 million adipose-mesenchymal stem cells mixed with platelet-rich plasma were injected into the internal fistula opening and fistula tract. The study included nine patients (seven females), with a median age of 36 years (r = 23-57). Eleven fistula tracks were treated, of which, two were pouch-vaginal fistulas. The median follow-up period was 31 months (r=21-37). At the end of the follow-up period, 10/11 (91%) fistulas were completely healed and 1/11 (9%) was partially healed. At the end of this period, there was no evidence of fistula relapse or adverse reactions in any patients. The Perianal Disease Activity Index and Inflammatory Bowel Disease Questionnaire scores significantly improved after the procedure. Combined therapy with adipose-mesenchymal stem cells, platelet-rich plasma and endorectal advancement flaps yielded good results in patients with refractory Perineal Crohn's Disease. This article is protected by copyright. All rights reserved.

Perianal inflammatory diseases : Classification and imaging

During the past 30years, classifications and scoring systems have been developed in order to evaluate and objectify the degree and activity of anorectal fistulas. Only afew of these disease-specific instruments have been adopted into daily clinical routine. Generally, clinicians tend to use global medical judgement rather than numeric activity indices, which often seem complex and time consuming. Activity scores in Crohn disease, however, appeared to be very useful in clinical trials regarding evaluation of therapy response. Thus, activity indices must be simple and reproducible. The years 1976 and 1995, in which the Parks Classification and Perianal Disease Activity Index (PDAI) were established, can be considered milestone years for classifying patients with anorectal fistulizing disease. These instruments should be recognized at present as the gold standard for evaluating the complexity as well as the severity of anorectal fistulas and perianal Crohn disease.

Certolizumab pegol in treatment of Crohn's disease with perianal lesions.

To assess the effectiveness of conservative treatment of Crohn's disease (CD) with perianal lesions. The study included 20 patients with CD with perianal fistulae. Prior to the start of conservative therapy, 7 patients underwent fistulae drainage with setton placement. During the study, all patients received therapy with certolizumab pegol (CP) for a year. At the time of treatment initiation and after 12 months, the CD activity index, the quality of life according to IBDQ questionnaires and the perianal Crohn's disease activity index (PCDAI) were assessed. After a year of CP therapy, clinical remission was achieved in 8 (40%) patients, endoscopic remission in 7 (35%) patients, fistula closure in 6 (30%) patients. There was also a decrease in the PCDAI with the average score 3.6 points compared to 9.3 points (p˂0.05) prior to the treatment. An improvement in the quality of life of patients was also established, the average quality of life index was 182,2 points compared to 156,0 points (p˂0.05) prior to the treatment. This study showed that CP therapy is effective in treatment of CD with perianal lesions.

Infliximab combined with sphincter-sparing surgery for the treatment of Perianal Crohn′s disease

Objective To evaluate the efficacy of infliximab combined with sphincter-sparing surgery in treatment of perianal Crohn′s disease. Methods Clinical data of 49 patients with perianal Crohn′s disease (3 cases with nonfistulizing perianal Crohn′s disease and 46 cases with fistulizing perianal Crohn′s disease) receiving infliximab combined with sphincter-sparing surgery in Jiangsu Province Hospital of TCM from May 2010 to June 2014 were analyzed retrospectively. The situation of fistula closure was assessed. C-reactive protein and perianal disease activity index were estimated by Wilcoxon method. Results No patient was failed to respond to primary treatment. patients (26/46) had a complete response to treatment, 28.3% patients (13/46) had a partial response and 15.2% patients (7/46) had lost response to treatment; 2 cases of anal ulcer healing; No other perianal lesion occurred in 1 case of verrucous skin. At final follow-up, CRP was decreased to[4.5(1.5, 15.9)]mg/L from [16.9(6.6, 35.6)] mg/L(Z=-3.994, P=0.00); PDAI was decreased to[1(0, 4.5)]from [7(4.5, 10.5)] (Z=-6.100, P=0.00). Conclusion Infliximab combined with sphincter-sparing surgery is effective for perianal Crohn′s disease. Key words: Anal canal; Retrospective studies; Surgical procedures, operative; Infliximab; Crohn′s disease

Analysis of clinical characteristics and treatment effect of perianal Crohn′s disease with or without proctitis

Objective To investigate the clinical characteristics of perianal Crohn′s disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation. Methods The retrospective cohort study was conducted. The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected. Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and non-proctitis group. All the 52 patients underwent surgery combined with infliximab therapy. Observation indicators included: (1) clinical characteristics: gender, age, body mass index (BMI), lesion location, disease behavior, type of perianal lesions, history of perianal surgeries, CD activity index (CDAI), perianal disease activity index (PDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), platelet (PLT) and albumin (Alb), (2) treatment and follow-up. Follow-up using outpatient examination was performed to evaluate the perianal lesions up to December 2015. Measurement data with normal distribution were described as ±s and comparison between groups was analyzed by the t test. Count data were described as the percentage, and comparison between groups was analyzed by the chi-square test and Fisher′s exact probability. Results (1) Clinical characteristics: number of patients with BMI normal level and =normal level, Alb 0.05). The total healed rate, improvement rate and unhealed rate of perianal lesion were 55.8%(29/52), 34.6%(18/52) and 9.6%(5/52), respectively. The number of patients with healed, improved and unhealed perianal lesions were 16, 11, 3 in the proctitis group and 13, 7, 2 in the non-proctitis group, respectively, showing no significant difference in treatment effects between the 2 groups (χ2=0.173, P>0.05). Conclusions Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis. However, there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis. Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis. Key words: Crohn′s disease; Anus disease; Proctitis; Clinical characteristics; Therapy

Role of transperineal ultrasonography (TPUS) in follow up of IBD patients with perianal disease

Introduction: The assessment of perianal disease is very important in IBD patients. In clinical practice, the outcome of medical or surgical treatment is evaluated mainly on the basis of physicians' subjective judgment. However, some objective scores for evaluating the efficacy of treatment have been proposed such as the Fistula Drainage Assessment (FDA) and the Perianal Disease Activity Index (PDAI). Specifically, FDA focuses on fistula drainage: a significant clinical improvement is present when at least 50% of fistulae is cured whereas complete remission is achieved when all fistulae are closed at the digital pressure in two consecutive visits. However, both FDA and PDAI give no information on the anatomical evolution of fistulae during medical treatment. Moreover, physical examination of the perineum is generally unable to differentiate between simple and complex fistulae according to the AGA classification although this information is crucial to assess the relationship between fistulae and anal sphincters and to determine the clinical outcome of IBD patients with perianal disease.

PTU-201 Living with anal fistulae

Introduction Around one in 10,000 people develop an idiopathic anal fistula and one third of patients with Crohn’s disease (CD) develop perianal fistulae. The associated morbidity of anal fistulae and its treatments can have profound effects on patients. The inflammatory bowel disease questionnaire (IBD-Q) has been used to assess the quality of life (QoL) of Crohn’s fistula patients on anti-TNF therapy. The Perianal Disease Activity Index (PDAI) has been used for the assessment of Crohn’s anal fistulae, although it mostly covers clinical aspects of the disease. Neither the IBD-Q nor the PDAI explore issues relating specifically to perianal fistulae. There are no specific idiopathic anal fistula QoL assessment tools. The aim of this study was to gain an understanding of the experience of perianal fistulae for Crohn’s and idiopathic fistula patients. Method Crohn’s and idiopathic fistula patients were identified from outpatient clinics, and invited to participate after reading the patient information sheets. Semi-structured interviews were conducted on 25 consenting fistula patients (20 Crohn’s, 5 idiopathic). Interviews were transcribed verbatim, and transcripts analysed independently by two researchers using a thematic analysis approach as guided by Colaizzi’s framework. Themes were identified relating to the experience of living with anal fistulae. Results Nine central themes were identified: diagnosis and acceptance (relief at getting a diagnosis which was explained to them), decision making (patients involvement in their treatment plan), coping strategies (having people around to provide support, or stocks of medical supplies in case of flares), body image (affecting patients’ self-esteem), stigma (including self- and perceived-stigma), relationships (detailing the difference between intimacy and companionship), social implications (including daily living activities and holidays), education and work (and the requirements for life adjustments) and clinical care issues such as having information regarding medical and surgical issues. Each of these main themes was divided into several subthemes. Conclusion Crohn’s and idiopathic anal fistulae are a major cause of distress and greatly impact on patients’ lives. The study findings have revealed new insights into specific issues related to living with perianal fistulae. These issues may lead to emotional, social, work-related and financial restrictions, which should be appreciated by health care professionals. There is a need for further research in this area to improve our understanding of the impact of anal fistulae on patients’ QoL and develop appropriate assessment tools designed specifically for this group of patients. Disclosure of interest None Declared.

Magnetic resonance imaging and clinical assessments for perianal Crohn's disease: Gain and limits

BackgroundAssessment of perianal Crohn's disease remains challenging. European Crohn's and Colitis Organisation (ECCO) recommend magnetic resonance imaging (MRI) as a gold standard, but both accuracy and advantages remain limited compared to systematic clinical assessment. The aim of this study was to define their actual diagnostic value. MethodsWe performed a retrospective analysis of a prospective database of consecutive patients with perianal Crohn's disease assessed by magnetic resonance imaging and clinical examination from 2006 to 2012. At each outpatient visit, perianal activity (Perianal Disease Activity Index) and perianal phenotype (Cardiff-Hughes classification) were noted. MRI was interpreted according to Cardiff-Hughes and Van Assche classifications. ResultsOverall, 122 combined evaluations were assessed in 70 patients. Radiological imaging failed to show superficial ulcerations in 20/21 patients (95%) and severe ulcerations in 13/15 patients (87%). It consistently failed to diagnose anal stenosis (n=21, 100%). For fistulising lesions, the global agreement between the two methods was 71/122 (58%) in assessing complex fistulas. Clinical assessment underestimated 44/68 (65%) of multiple or ramified fistula tracts. Clinical examination failed to diagnose half of the radiological abscesses. ConclusionsCurrent ECCO guidelines should be applied with some caution because of the low sensitivity of MRI for the diagnosis of non-fistulising perianal disease. Combining clinical and MRI assessments improves diagnostic accuracy.

Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up.

The aim of this study is to describe the long-term course of anorectal complains and function in a single centre cohort patients suffering from inflammatory bowel disease (IBD) with perianal lesions. Between 1993 and 2000, 56 IBD patients (43 Crohn's disease and 13 ulcerative colitis) with perianal complaints underwent anorectal function evaluation (AFE) (baseline). For follow-up, they were approached between 2010 and 2012 by sending questionnaires including Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ), Perianal Disease Activity Index (PDAI), faecal incontinence scale (Vaizey) and an invitation for AFE. At follow-up, 46 patients (82 %) were available, 9 (16 %) were lost and 1 (2 %) had died. Thirty patients returned the questionnaires of which 17 also underwent AFE. The remaining 16 patients were interviewed by phone and were only willing to mention their anorectal complaints. Median follow-up was 14 year. In 25 of the 46 patients (54 %), perianal complaints persisted faecal incontinence (n = 7); soiling (n = 13) and active fistula (n = 5). Eighteen (39 %) patients had an active fistula at baseline and three persisted at follow-up. Two developed a new fistula. Mean IBDQ, Vaizey and PDAI were 178 (SD 29), 7 (SD 5) and 4.2 (SD 3.0), respectively. In 17 patients, who underwent AFE, anal endosonography showed healing in nine of the ten fistulas. Anal pressures as well as rectal capacity remained unaltered in the individual patient, but showed a large range within the group. After 14 years, 54 % of the IBD patients with perianal lesions still have mild complaints. The quality of life remained moderate over a long period, which is concerning.

P575 A new tool for the surveillance of Crohn's perianal fistulae

Background: Magnetic Resonance Imaging (MRI) is the tool used to assess response to medical therapy for the treatment of perianal Crohn’s fistulae. Quantifying fistula volumes would be more beneficial than relying on subjective MRI reports. We aim to use computer software and MRI segmentation to design 3D models of fistula tracks and measure baseline and post-biologics treatment fistula volumes. Methods: Ten baseline and post-biologics MRI images of Crohn’s perianal fistulae were randomly selected. Three-Dimensional fistula models were independently created by a surgeon and radiologist • Manual fistula volumes were calculated for each patient and the results compared • Data were obtained on Perianal Disease Activity Index (PDAI) scores, clinical and radiological healing for these patients. Data were analysed using Spearman’s correlation to determine whether a change in fistula volume over a one-year period correlated with a change in PDAI score over the same time period. Fistula volumes and PDAI score were also correlated with degrees of clinical healing. Results: Baseline volumes for the surgeon showed a median of 9766mm3 (IQR 4636, 30980). Post-biologics volumes had a median of 4200mm3 (IQR 2720, 20070). A change in baseline and post-treatment volumes was also observed by the radiologist; the median volume was 9207mm3 (IQR 5132, 21710) for the baseline MRIs and 2872mm3 (IQR 1827, 18830) for the post-treatment ones.

Efficacy of tumor necrosis factor-alpha inhibitors in fistulising perianal Crohn’s disease

Tumor necrosis factor-alpha inhibitors are increasingly used in the treatment of severe Crohn's disease. The aim of the authors was to assess retrospectively the short and long term efficacy of tumor necrosis factor-alpha inhibitors in fistulising Crohn's disease. Responses to therapy was determined using Crohn's Disease Activity Index, Perianal Disease Activity Index, the rate of complete fistula closure and the additional surgical procedures during biological therapy. After 12 weeks the perianal activity was decreased in more than 80% of the cases, and the complete remission rate was about 60%. After one year of therapy about one third of the patients had fistula closure, but after cessation of the biological therapy recurrence of fistulas was detected in every second patient. In most cases additional immunosuppressive therapy was necessary during biological treatment. During the one-year therapy period additional surgical treatments were performed in 45% of patients; seton insertion and abscess drainage were the most frequent procedures. Tumor necrosis factor-alpha inhibitor therapy is effective in the treatment of perianal Crohn's disease, however, additional immunosuppressive drugs and rectum sparing surgical procedures were necessary during the one-year treatment period. Because of the high rate of fistula recurrence, long term tumor necrosis factor-alpha treatment may be useful.

OC-079 Development and Validation of New Clinical Disease Severity Index for Patients with Inflammatory Bowel Disease: a Prospective Multicentre Study

<h3>Introduction</h3> Due to the different presentations of patients with inflammatory bowel disease, several clinical severity indices were used in the past. Interestingly, most (if not all) of these indices were not properly validated and did not go through a robust methodology. Our aim is to develop a new clinical disease severity index that valid, easy obtainable in the clinic and suitable to all IBD patients. <h3>Methods</h3> The development of Swansea IBD clinical severity index (SICSI) followed a clinimetric approach. Items were devised using IBD experts opinions and through reviewing 17 clinical severity indices commonly used in studies for UC and CD. To ensure items are applicable, we asked a small focus group of IBD specialists, statisticians and methodologists to review these items and ensure good face and content validity. Psychometric properties were tested on 210 patients to remove redundant items and shorten the index. Construct validity was checked using biochemical markers like CRP, WBC, HB and albumin and clinical indices which are: Harvey Bradshaw index, simple clinical colitis activity index and perianal disease activity index. If patient is having an endoscopy, endoscopic indices will be recorded as well which are mayo clinic score, Rachmilewitz scores and simple endoscopic score. <h3>Results</h3> We found that 7 items account for 98% of the variance of the total score and they are: Abdominal pain or discomfort, stool consistency compared to the usual, blood in stool, number of stool frequency, general well being, nocturnal symptoms and urgency. Items that had high item total correlation &gt; 0.8 like physician global assessment were removed from the index as they are redundant. Temperature and abdominal mass had a zero variance score and did not add any value to the total score and were removed during factor analysis. Internal consistency (Correlation of items with each other) was acceptable (Cronbach alpha = 0.827). SICSI had good correlation with the clinical, biochemical and endoscopic severity scores (r &gt; 0.5). <h3>Conclusion</h3> It is clear that the Swansea IBD clinical severity index will perform well in clinical practise. Further studies are going on to implement the index in clincal practise. The index has been incorporated into our local IBD registry to follow up and moniter patients. There are plans to develop an iPhone application. <h3>Disclosure of Interest</h3> None Declared <h3>References</h3> Marx RG, C Bombardier C, Hogg-Johnson S, Wright JG. Clinimetric and psychometric strategies for development of a health measurement scale. J Clin Epidemiol, 1999. 52(2): p. 105–11. Streiner DL, Norman GR. Health measurement scales. A practical guided to their development uses. 4th ed, 2008 OUP.

Dynamic Contrast-Enhanced MRI in Determining Disease Activity in Perianal Fistulizing Crohn Disease: A Pilot Study

The objective of our study was to perform a semiquantitative analysis of dynamic contrast-enhanced MRI for the evaluation of disease activity and therapeutic response in patients with perianal fistulizing Crohn disease. Sixteen consecutively registered patients with perianal Crohn disease underwent pelvic MRI. A dynamic contrast-enhanced sequence was performed at 3 T (temporal resolution, 4.2 seconds) during i.v. contrast injection. Maximum enhancement, initial slope of increase, volume transfer constant (K(trans)), and the extravascular space fractional volume (x028B;(e)) were calculated in a region of interest drawn around the fistula. Perianal disease activity index, C-reactive protein concentration, and an MRI-based activity score were calculated as reference standards. Six patients underwent a second MRI examination 6 weeks after starting treatment with anti-tumor necrosis factor α (anti-TNF-α). Perianal disease activity index moderately correlated with maximum enhancement (r = 0.67, p = 0.005), initial slope of increase (r = 0.58, p = 0.018), and volume of enhancing pixels (r = 0.79, p < 0.001) but not with K(trans) or x028B;(e). Volume of enhancing pixels also correlated with C-reactive protein concentration and the MRI-based score (r = 0.52, p = 0.041; r = 0.79, p < 0.001). The K(trans) values had decreased significantly 6 weeks after the start of anti-TNF-α therapy. Maximum enhancement and initial slope of increase correlate with disease activity in perianal Crohn disease. K(trans) may be an indicator of the effect of therapy on patients starting anti-TNF-α treatment.

Traitement des fistules recto-vaginales de la maladie de Crohn par lambeau d’avancement vaginal

ObjectivesTo evaluate efficacy and functional results (sexual activity) of vaginal flap for rectovaginal fistula in Crohn's disease. Patients and methodsFrom May 2004 to March 2008, we proposed a vaginal flap in patients who had a rectovaginal fistula in Crohn's disease and for which rectal flap was technically impossible. Monitoring included a clinical examination at 1 month and every 3 months for 1 year, Perianal Disease Activity Index for sexual activity evaluation. Every year and in April 2009 the nursing team during a telephone interview filled a standardized questionnaire. ResultsWe treated 5 patients. At 6 months, 4 of 5 patients were healed. At 7 months, 1 patient presented a new flare up of CD with reopening of the fistula. The other 3 patients were still healed at a median follow-up of 30.66 months (15 to 59). One patient presented dyspareunia during 3 months. Discussion and conclusionVaginal flap is an effective technique that entails neither prolonged dyspareunia nor fecal incontinence. Stoma is not systematic.

Perifistular injection of Adalimumab in Fistulizing Cronhʼs disease patients

Fistulae will develop in approximately one-third of patients with Crohn's disease (CD). The management of fistulizing Crohn's Disease (FCD) patients has been a difficult problem with many possible treatment strategies. There are few studies evaluating local treatment of perianal fistula using adalimumab. Here, we report three cases of FCD treated with perifistular injection of adalimumab. Three patients presenting perianal FCD and previously treated with infliximab and azatioprine for one year were submitted to a perifistular injection of adalimumab during six weeks. Visits occurred in weeks 0, 2, 4, 6, and in each visit, respectively, was injected 160mg, 80mg, 40mg, 40mg of adalimumab. A final evaluation was made at week 8. During each visit the patient was evaluated according to the Perianal Disease Activity Index (PDAI). Case 1: The PDAI score was 15 at week 0, 9 at week 2, 6 at week 4, 3 at week 6, and 0 at week 8. The luminal CD was in remission (CDAI < 100). Case 2: The PDAI score was 11 at week 0, 6 at week 2, 3 at week 4, 3 at week 6 and 0 at week 8.Clinical remission was shown at week 8 (CDAI < 150).Case 3: The PDAI score was 4 at week 0, 0 at week 2, 4,6 and 8.He was in clinical remission (CDAI < 100). All patients had a complete closure of the fistulae at the end of eight weeks. Patients were evaluated at 6 months after receiving Adalimumab manteinance treatment SC at each 2 weeks. The fistulae relapsed in one patient. In conclusion, perifistular injection of adalimumab has shown very good results in closuring the perianal fistulae in CD patients.

Evaluation of an MRI-based score of disease activity in perianal fistulizing Crohn's disease

To evaluate a magnetic resonance imaging (MRI)-based score of disease severity for perianal fistulizing Crohn's disease (CD), 16 patients with perianal fistulizing CD underwent 1.5-T MRI before and after infliximab therapy. MRI scores, Perianal Disease Activity Index (PDAI) and C-reactive protein (CRP) were calculated, and fistula drainage was assessed. These items were compared for responders and nonresponders. After therapy, PDAI values and CRP values decreased significantly in responders, but there were no significant differences in the MRI scores. In all responders, MRI findings were indicative of persisting active inflammation. In these patients, a relapse rate of 57% was seen.

Endoanal ultrasonography may distinguish Crohn’s anal fistulae from cryptoglandular fistulae in patients with Crohn’s disease: a cross-sectional study

The aim of the study was a cross-sectional investigation into the types of anal fistulae in patients with Crohn's disease using 3-dimensional endoanal ultrasonography. The study population consisted of 45 patients with established Crohn's disease referred in a 2-year period for treatment of anal fistula. The fistulae were classified according to the presence of three criteria: 1. bifurcation or secondary extension; 2. cross-sectional width ≥ 3 mm; and 3. content of hyperechoic secretions. The fistulae of 24 patients (53%) satisfied two or three criteria and were classified as true Crohn's fistulae, while the fistulae of 21 patients satisfied one or none of the criteria and were the cryptoglandular type. The fistulae in the two or three criteria group had been in existence for 8.4 years on average and those in the cryptoglandular group for 4.5 years on average (P = 0.283). The corresponding numbers of previous operations for fistula were 5.7 (range 0-32) and 1.5 (range 0-6), respectively (P = 0.0211). The presence of colitis or proctitis was similar across the groups, but the perianal Crohn's disease activity index was higher with a Crohn's type of fistula (P = 0.0097). Also, a larger proportion had been treated with anti-TNF-monoclonal antibody (0.0169). Endoanal ultrasonography was capable of discerning two subgroups of fistula in Crohn's patients. These groups were clinically different indicating that the prospect of surgical cure is also different.

Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn's disease

To evaluate the diagnostic ability of contrast-enhanced Magnetic Resonance Imaging (MRI) in assessment of the activity of perianal fistulas in Crohn's disease (CD) patients, compared to clinical data. Fifty CD patients (25 men; mean[SD] age: 40.4[12.6] years) with known or suspected perianal fistulas underwent perianal space MRI. Radiological activity of disease was measured as the percentage increase (PI) of ROI values of fistulas in relation to ROI values of healthy local fat, after contrast administration. Clinical activity of disease was defined according to Perianal Disease Activity Index (PDAI) and Fistula Drainage Assessment (FDA). Forty-two patients presented perianal disease at MRI (55 fistulas identified). An association between both fistula's PI and PDAI (Pearson's coefficient 0.512, p<0.0001) and between PI and FDA (p=0.003) was demonstrated. Areas under ROC curves of PI values in relation to PDAI and FDA were respectively 0.876 [95%CI=(0.743-1.00), p<0.001] and 0.784 [95%CI=(0.588-0.980), p=0.003]. A cut-off value of PI, calculated on these preliminary data, correctly classified more than 90% of fistulas. Contrast-enhanced MRI with PI calculation offered practical information about activity of perianal fistulas and might be helpful in providing a comprehensive evaluation of CD perianal disease.