Professor Geert D'Haens and colleagues developed a consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease (pCD), based on best available evidence.
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.
|Drainage of sepsis is always first line therapy before initiating immunosuppressive treatment|
Evidence was assessed using the modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria.
The team report that highest diagnostic accuracy can only be established if a combination of modalities is used.
The team observed that drainage of sepsis is always first line therapy before initiating immunosuppressive treatment.
The research team found that 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.
Professor D'Haens' team concludes, "Conclusions Based on a multidisciplinary approach, items relevant for fistula management were identified and algorithms on diagnosis and treatment of pCD were developed."