G C Braithwaite1, M J Lee2,3, D Hind4, S R Brown5,4. 1. University of Sheffield Medical School, Sheffield, UK. 2. University of Sheffield Medical School, Sheffield, UK. m.j.lee@sheffield.ac.uk. 3. Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. m.j.lee@sheffield.ac.uk. 4. Clinical Trials Research Unit, University of Sheffield, Sheffield, UK. 5. Department of General Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
Abstract
BACKGROUND: One in three patients with Crohn's disease will develop a perianal fistulae, and one third of these will achieve long-term healing or closure. A barrier to conducting well-designed clinical trials for these patients is a lack of understanding of prognostic factors. This systematic review sets out to identify factors associated with prognosis of perianal Crohn's fistulae. METHODS: This review was registered on the PROSPERO database (CRD42016050316) and conducted in line with PRISMA guidelines along a predefined protocol. English-language studies assessing baseline factors related to outcomes of fistulae treatment in adult patients were included. Searches were performed on MEDLINE and Embase databases. Screening of abstracts and full texts for eligibility was performed prior to extraction of data into predesigned forms. Bias was assessed using the QUIPS tool. RESULTS: Searches identified 997 papers. Following removal of duplicates and secondary searches, 923 were screened for inclusion. Forty-seven papers were reviewed at full-text level and 13, 2 of which were randomised trials, were included in the final qualitative review. Two studies reported distribution of Crohn's disease as a prognostic factor for healing. Two studies found that CARD15 mutations decreased response of fistulae to antibiotics. Complexity of fistulae anatomy was implicated in prognosis by 4 studies. CONCLUSIONS: This systematic review has identified potential prognostic markers, including genetic factors and disease behaviour. We cannot, however, draw robust conclusions from this heterogeneous group of studies; therefore, we recommend that a prospective cohort study of well-characterised patients with Crohn's perianal fistulae is undertaken.
BACKGROUND: One in three patients with Crohn's disease will develop a perianal fistulae, and one third of these will achieve long-term healing or closure. A barrier to conducting well-designed clinical trials for these patients is a lack of understanding of prognostic factors. This systematic review sets out to identify factors associated with prognosis of perianal Crohn's fistulae. METHODS: This review was registered on the PROSPERO database (CRD42016050316) and conducted in line with PRISMA guidelines along a predefined protocol. English-language studies assessing baseline factors related to outcomes of fistulae treatment in adult patients were included. Searches were performed on MEDLINE and Embase databases. Screening of abstracts and full texts for eligibility was performed prior to extraction of data into predesigned forms. Bias was assessed using the QUIPS tool. RESULTS: Searches identified 997 papers. Following removal of duplicates and secondary searches, 923 were screened for inclusion. Forty-seven papers were reviewed at full-text level and 13, 2 of which were randomised trials, were included in the final qualitative review. Two studies reported distribution of Crohn's disease as a prognostic factor for healing. Two studies found that CARD15 mutations decreased response of fistulae to antibiotics. Complexity of fistulae anatomy was implicated in prognosis by 4 studies. CONCLUSIONS: This systematic review has identified potential prognostic markers, including genetic factors and disease behaviour. We cannot, however, draw robust conclusions from this heterogeneous group of studies; therefore, we recommend that a prospective cohort study of well-characterised patients with Crohn's perianal fistulae is undertaken.
Authors: Tiago Nunes; Maria Josefina Etchevers; Valle García-Sánchez; Daniel Ginard; Eva Martí; Manuel Barreiro-de Acosta; Fernando Gomollón; Maite Arroyo; Guillermo Bastida; Benito Gonzalez; David Monfort; Esther García-Planella; Carolina Figueroa; Julián Panés; Miquel Sans Journal: Am J Gastroenterol Date: 2016-02-09 Impact factor: 10.864
Authors: Floris Imhann; Arnau Vich Vila; Marc Jan Bonder; Jingyuan Fu; Dirk Gevers; Marijn C Visschedijk; Lieke M Spekhorst; Rudi Alberts; Lude Franke; Hendrik M van Dullemen; Rinze W F Ter Steege; Curtis Huttenhower; Gerard Dijkstra; Ramnik J Xavier; Eleonora A M Festen; Cisca Wijmenga; Alexandra Zhernakova; Rinse K Weersma Journal: Gut Date: 2016-10-08 Impact factor: 23.059
Authors: S Lichtiger; D G Binion; D C Wolf; D H Present; A G Bensimon; E Wu; A P Yu; A T Cardoso; J Chao; P M Mulani; K G Lomax; J D Kent Journal: Aliment Pharmacol Ther Date: 2010-09-28 Impact factor: 8.171
Authors: J Tiernan; A Cook; I Geh; B George; L Magill; J Northover; A Verjee; J Wheeler; N Fearnhead Journal: Colorectal Dis Date: 2014-12 Impact factor: 3.788
Authors: D Bouchard; F Pigot; G Staumont; L Siproudhis; L Abramowitz; P Benfredj; C Brochard; N Fathallah; J-L Faucheron; T Higuero; Y Panis; V de Parades; B Vinson-Bonnet; D Laharie Journal: Tech Coloproctol Date: 2019-01-02 Impact factor: 3.781