Paulo Gustavo Kotze1, Idblan Carvalho de Albuquerque2, André da Luz Moreira3, Wanessa Bertrami Tonini1, Marcia Olandoski1, Claudio Saddy Rodrigues Coy4. 1. Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, Universidade Católica do Paraná - PUCPR, Curitiba, PR, Brasil. 2. Unidade de Doenças Inflamatórias Intestinais, Hospital Heliópolis, São Paulo, SP, Brasil. 3. Unidade de Cirurgia Colorretal, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brasil. 4. Unidade de Cirurgia Colorretal, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil.
Abstract
BACKGROUND: Perianal fistulizing Crohn's disease is one of the most severe phenotypes of inflammatory bowel diseases. Combined therapy with seton placement and anti-TNF therapy is the most common strategy for this condition. OBJECTIVES: The aim of this study was to analyze the rates of complete perianal remission after combined therapy for perianal fistulizing Crohn's disease. METHODS: This was a retrospective observational study with perianal fistulizing Crohn's disease patients submitted to combined therapy from four inflammatory bowel diseases referral centers. We analyzed patients' demographic characteristics, Montreal classification, concomitant medication, classification of the fistulae, occurrence of perianal complete remission and recurrence after remission. Complete perianal remission was defined as absence of drainage from the fistulae associated with seton removal. DISCUSSION: A total of 78 patients were included, 44 (55.8%) females with a mean age of 33.8 (±15) years. Most patients were treated with Infliximab, 66.2%, than with Adalimumab, 33.8%. Complex fistulae were found in 52/78 patients (66.7%). After a medium follow-up of 48.2 months, 41/78 patients (52.6%) had complete perianal remission (95% CI: 43.5%-63.6%). Recurrence occurred in four (9.8%) patients (95% CI: 0.7%-18.8%) in an average period of 74.8 months. CONCLUSIONS: Combined therapy lead to favorable and durable results in perianal fistulizing Crohn's disease.
BACKGROUND: Perianal fistulizing Crohn's disease is one of the most severe phenotypes of inflammatory bowel diseases. Combined therapy with seton placement and anti-TNF therapy is the most common strategy for this condition. OBJECTIVES: The aim of this study was to analyze the rates of complete perianal remission after combined therapy for perianal fistulizing Crohn's disease. METHODS: This was a retrospective observational study with perianal fistulizing Crohn's diseasepatients submitted to combined therapy from four inflammatory bowel diseases referral centers. We analyzed patients' demographic characteristics, Montreal classification, concomitant medication, classification of the fistulae, occurrence of perianal complete remission and recurrence after remission. Complete perianal remission was defined as absence of drainage from the fistulae associated with seton removal. DISCUSSION: A total of 78 patients were included, 44 (55.8%) females with a mean age of 33.8 (±15) years. Most patients were treated with Infliximab, 66.2%, than with Adalimumab, 33.8%. Complex fistulae were found in 52/78 patients (66.7%). After a medium follow-up of 48.2 months, 41/78 patients (52.6%) had complete perianal remission (95% CI: 43.5%-63.6%). Recurrence occurred in four (9.8%) patients (95% CI: 0.7%-18.8%) in an average period of 74.8 months. CONCLUSIONS: Combined therapy lead to favorable and durable results in perianal fistulizing Crohn's disease.