Long-term outcomes in perianal fistulizing Crohn's disease in a resource-limited setting: A cohort analysis.
Indian J Gastroenterol. 2020 Oct 10;:
Authors: Vuyyuru SK, Sahu P, Kedia S, Kante B, Kumar P, Ranjan MK, Sharma R, Makharia G, Gupta SD, Sahni P, Ahuja V
BACKGROUND: Perianal fistula is one of the most challenging complications of Crohn's disease (CD). We aimed to describe treatment response with surgical and medical therapies, and long-term complications.
METHODS: We retrospectively analyzed records of patients with perianal fistulizing CD who were prospectively followed from January 2005 to December 2018.
RESULTS: Among 807 patients, 81 (10%) had perianal fistula and 65 were included in the final analysis. The mean age of presentation was 27.4β±β10.3 years, and 78.5% were males with a median duration of follow-up of 45 (IQR, 24-66) months. 75.4% (nβ=β49) had complex fistulae. 55.4% (nβ=β36) of patients received multiple courses (>β5 courses) of antibiotics. Complete response rates with immunomodulators, fistula surgery, biologicals, and diversion were 25%, 42.8%, 39.5%, and 45.4%, respectively. The relapse rate was highest after fistula surgery (52.6%). 44.6% of patients received medical (immunomodulators-21 and biologicals-8) whereas 46.1% received surgery as the first-line therapy. The absence of perianal abscess was associated with complete fistula closure. One patient developed malignancy and 4 (6.1%) died at the end of follow-up. Among the patients (nβ=β28) who received biologicals, TB reactivation occurred in one patient (3.5%).
CONCLUSION: Medical therapy should be offered as first-line therapy, and immunomodulators can be considered when patients cannot afford biologicals. Surgery offers temporary improvement and is associated with high relapse rates. Absence of perianal abscess predicts long-term complete fistula closure.
PMID: 33040321 [PubMed - as supplied by publisher]
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