Management of Anal Fistula with Crohn's Disease
Crohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacer...
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| Format: | Article |
| Language: | English |
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The Japan Society of Coloproctology
2025-01-01
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| Series: | Journal of the Anus, Rectum and Colon |
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| Online Access: | https://www.jstage.jst.go.jp/article/jarc/9/1/9_2024-067/_pdf/-char/en |
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| _version_ | 1832584952527454208 |
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| author | Shota Takano Yasushi Nakamura Kohei Tamaoka Takafumi Yoshimoto Yasue Irei Yoriyuki Tsuji |
| author_facet | Shota Takano Yasushi Nakamura Kohei Tamaoka Takafumi Yoshimoto Yasue Irei Yoriyuki Tsuji |
| author_sort | Shota Takano |
| collection | DOAJ |
| description | Crohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacerbated by perianal abscesses and/or fistulas. Perianal fistulizing CD (PFCD) has an unknown etiology and recurring symptoms such as pain and discharge, which seriously affects the patient's quality of life (QOL). In the past, radical surgery was performed for PFCD, but due to the risk of anal sphincter impairment, conservative therapy using antibiotics and immunosuppressive medications is currently the first treatment option. PFCD management has greatly improved with the use of biologics such as the antitumor necrosis factor alpha (TNF-α) antibodies infliximab and adalimumab. In this review, the results of the administration of anti-TNF-α (certolizumab pegol), anti-interleukin-12/23 (ustekinumab), and anti-α4β7 integrin antibodies (vedolizumab) were evaluated. Our investigation showed that these medications may be effective for maintenance therapy to prevent the recurrence of anal fistulas. In addition to biologics, molecular target drugs and even regenerative medicine using mesenchymal stem cells have been introduced to further expand the treatment options for consideration by medical personnel. We herein discuss the management of PFCD by focusing on studies conducted in the United States and Europe where researchers used recommended guidelines and consensus statements to evaluate the efficacy of each medication and published their findings in peer-reviewed journals. |
| format | Article |
| id | doaj-art-b4583676229f4bd7b5bc9783f41c0a99 |
| institution | Kabale University |
| issn | 2432-3853 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | The Japan Society of Coloproctology |
| record_format | Article |
| series | Journal of the Anus, Rectum and Colon |
| spelling | doaj-art-b4583676229f4bd7b5bc9783f41c0a992025-01-27T10:02:40ZengThe Japan Society of ColoproctologyJournal of the Anus, Rectum and Colon2432-38532025-01-0191101910.23922/jarc.2024-0672024-067Management of Anal Fistula with Crohn's DiseaseShota Takano0Yasushi Nakamura1Kohei Tamaoka2Takafumi Yoshimoto3Yasue Irei4Yoriyuki Tsuji5Inflammatory Bowel Disease Center, Coloproctology Center Takano HospitalInflammatory Bowel Disease Center, Coloproctology Center Takano HospitalInflammatory Bowel Disease Center, Coloproctology Center Takano HospitalInflammatory Bowel Disease Center, Coloproctology Center Takano HospitalInflammatory Bowel Disease Center, Coloproctology Center Takano HospitalInflammatory Bowel Disease Center, Coloproctology Center Takano HospitalCrohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacerbated by perianal abscesses and/or fistulas. Perianal fistulizing CD (PFCD) has an unknown etiology and recurring symptoms such as pain and discharge, which seriously affects the patient's quality of life (QOL). In the past, radical surgery was performed for PFCD, but due to the risk of anal sphincter impairment, conservative therapy using antibiotics and immunosuppressive medications is currently the first treatment option. PFCD management has greatly improved with the use of biologics such as the antitumor necrosis factor alpha (TNF-α) antibodies infliximab and adalimumab. In this review, the results of the administration of anti-TNF-α (certolizumab pegol), anti-interleukin-12/23 (ustekinumab), and anti-α4β7 integrin antibodies (vedolizumab) were evaluated. Our investigation showed that these medications may be effective for maintenance therapy to prevent the recurrence of anal fistulas. In addition to biologics, molecular target drugs and even regenerative medicine using mesenchymal stem cells have been introduced to further expand the treatment options for consideration by medical personnel. We herein discuss the management of PFCD by focusing on studies conducted in the United States and Europe where researchers used recommended guidelines and consensus statements to evaluate the efficacy of each medication and published their findings in peer-reviewed journals.https://www.jstage.jst.go.jp/article/jarc/9/1/9_2024-067/_pdf/-char/encrohn's diseaseperianal fistula |
| spellingShingle | Shota Takano Yasushi Nakamura Kohei Tamaoka Takafumi Yoshimoto Yasue Irei Yoriyuki Tsuji Management of Anal Fistula with Crohn's Disease Journal of the Anus, Rectum and Colon crohn's disease perianal fistula |
| title | Management of Anal Fistula with Crohn's Disease |
| title_full | Management of Anal Fistula with Crohn's Disease |
| title_fullStr | Management of Anal Fistula with Crohn's Disease |
| title_full_unstemmed | Management of Anal Fistula with Crohn's Disease |
| title_short | Management of Anal Fistula with Crohn's Disease |
| title_sort | management of anal fistula with crohn s disease |
| topic | crohn's disease perianal fistula |
| url | https://www.jstage.jst.go.jp/article/jarc/9/1/9_2024-067/_pdf/-char/en |
| work_keys_str_mv | AT shotatakano managementofanalfistulawithcrohnsdisease AT yasushinakamura managementofanalfistulawithcrohnsdisease AT koheitamaoka managementofanalfistulawithcrohnsdisease AT takafumiyoshimoto managementofanalfistulawithcrohnsdisease AT yasueirei managementofanalfistulawithcrohnsdisease AT yoriyukitsuji managementofanalfistulawithcrohnsdisease |