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Crohn's Disease Forum » Books, Multimedia, Research & News » Medical Treatment Options for Perianal Crohn's Disease


11-28-2012, 09:58 PM   #1
David
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Medical Treatment Options for Perianal Crohn's Disease

The article, "Medical Treatment Options for Perianal Crohn's Disease" by Sara N Horst and David A. Schwartz is found on pages 729-734 of the book, "Advanced Therapy in Inflammatory Bowel Disease" and is supported by 14 references. For any of you interested in the deeper medical side of Crohn's Disease, this book is fantastic but be warned, it is aimed at medical practitioners and is heavy reading. This thread will contain information I feel is useful in the article and I also open it up for discussion.

- The first symptoms of perianal Crohn's disease are usually pain and/or drainage.
- Medical treatment of perianal Crohn's works best if a surgeon has drained any abscesses and placed setons in any fistulae.
- Perianal fistula rates among people with Crohn's range between 17% and 43%.
- 54% of fistulas are in the perianal area.
- People with rectal inflammation are at the greatest risk of developing perianal Crohn's disease. One study showcased that 90% of people with perianal fistula had colon and rectal inflammation. Whereas 41% who had colon inflammation but rectal sparing had perianal fistula and only 12% of those with small bowel disease had perianal fistula.
- In one study, 35% of perianal fistula recurred and the mean closure time was 14 weeks. The mean recurrence time was 2.8 years and 21% required proctectomy.
- There are two classification schemes for perianal fistula. The Parks classification and the simple/complex classification.
- The Parks classification uses intersphincteric, transphincteric, suprasphincteric, extraspincteric, and superficial.
- Anti-TNF and immunosuppressive medications are effective for perianal disease.
- Antibiotics are commonly used for perianal disease as the deal with the sepsis and inflammation. Metronidazole and Ciprofloxacin are the most commonly used for 2-4 months.
- A study of metronidazole at 20mg/kg/day had all patients report a reduction in pain and tenderness and 83% had fistula closure. However, recurrence is common after discontinuation.
- A study of 52 patients had three groups. Antibiotics only, azathioprine added to antibiotics after 8 weeks, and antibiotics added to those already on azathioprine. At week 8, 50% had responded to antibiotics. At week 20, those who were also on azathioprine were more likely to maintain the response with a rate of 48% versus 15%.
- In a meta analysis of 70 patients, 54% of patients on azathioprine of 6-MP had perianal fistula closure versus 21% for placebo.
- IV Cyclosporine can be used as a bridge therapy with 83% of patients responding within 1-2 weeks.
- For patients with refractory perianal Crohn's disease, Tacrolimus has been shown to help 43% of patients versus 8% taking the placebo.
- Infliximab (Remicade) has been shown to be effective in perianal Crohn's disease. In one study, 55% of people on 5mg/kg and 38% of people on 10mg/kg versus 13% placebo had fistula closure. Mean closure time was 3 months.
- Adalimumab (Humira) had 39% of patients versus 13% experience fistula closure at week 56 in the CHARM trial. Of those who took the Humira, 90% maintained closure at 1 years and 60% at year 2.
- The author suggests utilizing the, "top down" approach for perianal Crohn's disease but stresses that surgical drainage of abscess and application of setons to fistula is of utmost importance.
12-18-2012, 04:08 AM   #2
sashaz
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When I had one that wouldn't go away my gp took a swab and matched the antibiotic to get rid of that specific bacteria.
12-18-2012, 08:34 AM   #3
Tina80
 
Join Date: Sep 2012
Location: Glasgow, United Kingdom
This seems very interesting David. I wondered if it mentioned anything about perianal disease being the presenting symptom of Crohns? The reason I ask is that it took another 5 years for me to be diagnosed after numerous abscesses and fistula. The disease did not show up anywhere else during initial tests until it eventually appeared in my small bowel by which point I had 3 strictures! I aslo often wonder why I have such perianal complications when my disease is limited to the small bowel. Just my luck I guess! Although my latest pathology results from my last colonoscopy showed it in the large bowel to the surprise of my consultant who told me at the time it looked fine. Anyone with any similar experiences?
04-04-2013, 08:52 AM   #4
BoyMama2000
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Join Date: Sep 2011
Location: Denver-Boulder, Colorado
My son only has ileal disease and developed at abscess and fistula 15 months after diagnosis. They just saw through a video capsule that he is in a flare of his ileum but I want to inquire about another colonoscopy to see if he has colonic or rectal disease since he now has peri-anal disease. What meds do you take? Ho are you doing now?
04-04-2013, 10:41 AM   #5
guest78
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i have been suffering from bleeding due to a flare/perianal flare.
steroids/humira/antibiotics/aza havent stopped it.
it started June 2012 and has worsened.
Any ideas?
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Diagnosed Jan 2008, aged 16
Now 21
Currently on:
Humira - weekly
Aza 125mg

New Ileostomy, 'Margaret' born June 6th 2013

Calcium, Vit D, Magnesium, Pro-Biotics


Previous:
Pentasa, Infliximab, Pred
04-04-2013, 10:52 AM   #6
BoyMama2000
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GEC - Have you looked at the treatment link for LDN? It sounds like there have been some great results with perianal disease as well as other Crohn's healing. It is also an inexpensive drug with a low side effect profile.

Hope you get better soon.
06-04-2014, 09:11 AM   #7
Jay Woodman
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Location: Nova Scotia

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The article, "Medical Treatment Options for Perianal Crohn's Disease" by Sara N Horst and David A. Schwartz is found on pages 729-734 of the book, "Advanced Therapy in Inflammatory Bowel Disease" and is supported by 14 references. For any of you interested in the deeper medical side of Crohn's Disease, this book is fantastic but be warned, it is aimed at medical practitioners and is heavy reading. This thread will contain information I feel is useful in the article and I also open it up for discussion.

-
- The author suggests utilizing the, "top down" approach for perianal Crohn's disease but stresses that surgical drainage of abscess and application of setons to fistula is of utmost importance.
My GI has also recommended the "top down" approach with Humira to start ASAP for my Perianal Crohn's - abscesses, fistulas & setons. With a less then
50% chance of fistula closure with Humira I am really having a difficult time understanding this aggressive approach. It sounds like this material also identifies other medications are also equally effective for Perianal Crohn's.
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Perianal Crohn's
Curcumin
Garlic
Grape Seed Extract
Vitamin C
Vitamin D - 5000 IU Daily
Omega 3 - 2 teaspoons NutraSea daily
Methotrexate
Remicade (+Hydrocortisone)
06-04-2014, 04:32 PM   #8
David
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Jay, I'm a fan of the top down approach. However, based upon your interests in treatments like LDN, I suggest checking out the clinical trial in my signature as well.
06-04-2014, 06:35 PM   #9
Jay Woodman
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Jay, I'm a fan of the top down approach. However, based upon your interests in treatments like LDN, I suggest checking out the clinical trial in my signature as well.
Thanks David! I am very impressed with your amazing contribution to this Forum. I am currently feeling very anxious with respect to proceeding with Humira treatment given it's black box warning & product monograph. However, I am slowly beginning to understand the current pharmaceutical options available to Crohn's patients may be better than a progressive disease left untreated.
Thanks to your signature line I have already made an inquiry wrt Qu.
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