Krisztina B Gecse1, Shaji Sebastian2, Gert de Hertogh3, Nuha A Yassin4, Paulo G Kotze5, Walter Reinisch6, Antonino Spinelli7, Ioannis E Koutroubakis8, Konstantinos H Katsanos9, Ailsa Hart10, Gijs R van den Brink11, Gerhard Rogler12, Willem A Bemelman13. 1. First Department of Medicine, Semmelweis University, Budapest, Hungary krisztina.gecse@gmail.com. 2. Inflammatory Bowel Disease Unit, Hull & East Yorkshire NHS Trust, Hull, UK. 3. Department of Pathology, University of Leuven, Leuven, Belgium. 4. Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, London, UK. 5. Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil. 6. Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada. 7. Colorectal Surgery Unit, Humanitas Research Hospital, Humanitas University, Milan, Italy. 8. Department of Gastroenterology, University Hospital Heraklion, Iraklio, Greece. 9. Division of Gastroenterology, Department of Medicine, School of Health Sciences, Ioannina, Greece. 10. Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK. 11. Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 12. Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland. 13. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND AND AIMS: Perianal fistulas affect up to one-third of Crohn's patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohn's and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn's disease [CD]. METHODS: The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn's disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed. RESULTS: Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD. CONCLUSIONS: The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.
BACKGROUND AND AIMS: Perianal fistulas affect up to one-third of Crohn's patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohn's and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn's disease [CD]. METHODS: The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn's disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed. RESULTS: Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD. CONCLUSIONS: The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.
Authors: Sang Hyoung Park; Satimai Aniwan; W Scott Harmsen; William J Tremaine; Amy L Lightner; William A Faubion; Edward V Loftus Journal: Inflamm Bowel Dis Date: 2019-05-04 Impact factor: 5.325
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