Treatment of Anorectal Fistula in Crohn's Disease
This protocol addresses symptomatic anorectal fistula occurring in the setting of Crohn's disease — a fistulizing manifestation that typically requires a coordinated surgical and medical strategy.
Clinical Scenario
Anorectal fistula associated with Crohn's disease is typically managed with a combination of surgical and medical approaches. The presence of active Crohn's disease shapes both the choice of therapy and the timing of any intervention.
Treatment Approach
The mainstay of medical management of anorectal Crohn's disease is biological therapy, which in many instances is combined — at least initially — with a surgical drainage component. For patients in whom drainage is not required, a distinct medical pathway is available.
The complete regimen, including agent selection, combination strategy, and sequencing, is in the full protocol below.
Treatment Goal
The primary outcome target is a reduction of more than 50% in the number of actively draining fistulas, assessed at week 14 of treatment.
References
DOI: 10.1097/DCR.0000000000002473
- Anorectal fistula associated with Crohn's disease is typically managed with a combination of surgical and medical approaches.
- The mainstay of medical management of anorectal Crohn's disease is biological therapy.
- In many instances, medical therapy is combined, at least initially, with a draining seton.
- Draining setons are typically useful in the multimodality therapy of fistulizing anorectal Crohn's disease and may be used for long-term disease control.
- At week 14, a response, defined as more than 50% reduction in the number of draining fistulas, was observed in 195 patients (69%), whereas 87 patients (31%) showed no response.
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