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Gut. 2014 Sep;63(9):1381-92. doi: 10.1136/gutjnl-2013-306709. Epub 2014 Jun 20.

A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease.

Author information

  • 1Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Robarts Research Institute, Amsterdam, The Netherlands.
  • 2Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
  • 3St. Vincent's Hospital and University of Melbourne, Melbourne, Australia.
  • 4Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
  • 5Robarts Research Institute, London, Ontario, Canada University of Western Ontario, London, Ontario, Canada.
  • 6Department of Medicine and Therapeutics, Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.
  • 7Department of Gastroenterology, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
  • 8Department of Gastroenterology, University of Leuven, Leuven, Belgium.
  • 9Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
  • 10APRG, Imperial College, London, UK IBD Unit, St. Mark's Hospital, London, UK.
  • 11Robarts Research Institute, San Diego, CA, USA Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.

Abstract

OBJECTIVE:

To develop a consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease (pCD), based on best available evidence.

METHODS:

Based on a systematic literature review, statements were formed, discussed and approved in multiple rounds by the 20 working group participants. Consensus was defined as at least 80% agreement among voters. Evidence was assessed using the modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria.

RESULTS:

Highest diagnostic accuracy can only be established if a combination of modalities is used. Drainage of sepsis is always first line therapy before initiating immunosuppressive treatment. Mucosal healing is the goal in the presence of proctitis. Whereas antibiotics and thiopurines have a role as adjunctive treatments in pCD, anti-tumour necrosis factor (anti-TNF) is the current gold standard. The efficacy of infliximab is best documented although adalimumab and certolizumab pegol are moderately effective. Oral tacrolimus could be used in patients failing anti-TNF therapy. Definite surgical repair is only of consideration in the absence of luminal inflammation.

CONCLUSIONS:

Based on a multidisciplinary approach, items relevant for fistula management were identified and algorithms on diagnosis and treatment of pCD were developed.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

KEYWORDS:

Crohn's Disease; Gastrointestinal Fistulae; IBD Clinical; Infliximab

PMID:
24951257
[PubMed - indexed for MEDLINE]
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