scholarly journals Managing complex perianal disease after anti-TNF failure: Where to go next?

2022 ◽  
pp. 100081
Author(s):  
Clare Yzet ◽  
Franck Brazier ◽  
Charles Sabbagh ◽  
Mathurin Fumery
Keyword(s):  
Perianal Disease

Does perianal disease influence the efficacy of combination therapy in Crohn’s disease?

2020 ◽  
Author(s):  
Rui de Sousa Magalhães ◽  
Sofia Xavier ◽  
Tiago Cúrdia Gonçalves ◽  
Francisca Dias de Castro ◽  
Bruno Rosa ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Clinical Remission ◽  
Odds Ratio ◽  
Perianal Disease ◽  
Outcome Variable ◽  
P Value ◽  
Disease Relapse ◽  
Endoscopic Remission ◽  
Remission Rates ◽  
One Year

Background: Perianal disease is associated with a disabling course of CD. We aim to study the impact of perianal disease on CD remission rates, after a one-year course of infliximab in combination therapy with azathioprine. Methods: Cohort, retrospective, single centre study, including consecutive CD patients on combination therapy, followed for one year since induction. The outcome variable was split into clinical and endoscopic remission. The correlation towards the outcome variable was assessed with univariate and multivariate analysis, and a survival assessment, using SPSS software. Results: We assessed 74 CD patients, of whom 41 (55.4%) were female, with a mean age of 36 years-old. Thirty-nine percent of the patients presented perianal disease at diagnosis (n=29). We documented 70.3% clinical and 47.2% endoscopic remissions. Several variables had statistical significance towards the outcomes (endoscopic and clinical remission) in the univariate analysis. After adjusting for confoundment, patients with perianal disease presented an odds ratio of 0.20 for achieving endoscopic remission (odds ratio 0.201 CI [0.054-0.75] p-value 0.017) and an odds ratio of 0.203 for achieving clinical remission (OR 0.203 CI [0.048-0.862] p-value 0.031). Sixty-six patients (89.2%) presented an initial response to treatment, from whom, 20 (30.3%) exhibited at least one disease relapse (clinical and/or endoscopic). Patients with perianal disease presented higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meyer curves (Breslow p-value 0.043). Conclusion: In the first year of combination therapy, perianal disease is associated with an 80% decrease in endoscopic and clinical remission rates and higher ratio of disease relapse.

Perianal Crohn's Disease in Children and Adolescents

2020 ◽  
Vol 30 (05) ◽  
pp. 395-400
Author(s):  
Annika Mutanen ◽  
Mikko P. Pakarinen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Children And Adolescents ◽  
Perianal Disease ◽  
Ileocecal Region ◽  
Perianal Crohn’S Disease ◽  
Perianal Sepsis ◽  
Endoscopic Assessment ◽  
Perianal Crohn's Disease

AbstractThe incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease localization in the ileocecal region and colon, often associated with perianal disease. Severe complications of perianal disease include recurrent perianal sepsis, chronic fistulae, fecal incontinence, and rectal strictures that impair quality of life and may require fecal diversion. Care of patients with perianal Crohn's disease requires a multidisciplinary approach with systematic clinical evaluation, endoscopic assessment, and imaging studies followed by combined medical and surgical management. In this review, we provide an update of the epidemiology, pathophysiology, diagnostics, and management of perianal Crohn's disease in children and adolescents.

Perianal disease remains an understudied and difficult complication in leukemia patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19016-e19016
Author(s):  
Shreya Gupta ◽  
Nirav Patil ◽  
Emily Steinhagen-Golbig ◽  
Benjamin Kent Tomlinson ◽  
Sharon Stein ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Cost ◽  
Hospital Costs ◽  
Perianal Abscess ◽  
Lymphocytic Leukemia ◽  
Operative Intervention ◽  
Perianal Disease ◽  
Categorical Variables ◽  
Continuous Variables

e19016 Background: Perianal infection is a rare and poorly understood complication of patients with acute myeloid/lymphocytic leukemia (AML/ALL). With the advancements in oncology, patients are living longer in an immunocompromised state and thus bearing the inherent problems such as infections that arise with it. Perianal infection and its management impacts patients' quality of life as well as interrupts their ongoing oncologic treatment. The optimal treatment strategy for perianal infections in this highly immunocompromised group remains unclear, as does the selection and outcomes of patients for operative intervention. The aim of this study is to identify patient characteristics associated with perianal infection and to delineate outcomes in patients that undergo operative intervention. Methods: The National Inpatient Sample (NIS) database was used to identify hospitalized patients with diagnoses of perianal abscess and AML/ALL between 2007 and 2015. Patient data were weighted to obtain national estimates. Demographics and clinical characteristics were compared between patients with and without perianal disease using Rao-Scott Chi-square test for categorical variables, and weighted simple linear regression for continuous variables. Characteristics and outcomes were compared between patients who underwent operative or non-operative management. Results: There were 12,626 (0.7%) patients with perianal disease among 1,782,778 AML/ALL patient admissions. Patients with perianal disease were more likely to be younger (43.9 (42.5 – 45.3) years, p < 0.001), male (67.4% vs 32.6%, p < 0.001) and white (65.8% vs 54.8%, p < 0.001). Length of stay (18.4 days vs 9 days, p < 0.001) and hospital cost ($54K vs $25K, p < 0.001) were higher in those with perianal disease, but there was no difference in in-hospital mortality (5.5% in those with perianal diseases vs 6.2% in those without, p = 0.150). Greater proportion of patients without perianal disease were discharged to hospice (12.6% patients without perianal disease vs 5.1% patients with perianal disease, p < 0.001). Receiving a surgical intervention did not improve outcomes with respect to in-hospital mortality (5.9% operative vs 5.4 non-operative, p = 0.596), length of stay (20.2 days vs 18.2 days, p = 0.582) or hospital cost ($67K vs $53K, p = 0.525). Conclusions: Perianal disease is a rare but distressing complication in AML/ALL patients associated with longer hospital stays and higher hospital costs. Operative intervention for perianal disease did not reduce rates of in-hospital mortality, length of stay or hospital cost but it does impact the probability of discharge to hospice. Non-operative and operative intervention both remain equivocal in changing the outcomes these patients. Further studies are required to examine these associations and determine best practices for treatment of this condition in this complex patient population.

Medical Therapy for Crohn Disease

2015 ◽  
Author(s):  
Jessica R Allegretti ◽  
Joshua R. Korzenik
Keyword(s):  
Disease Activity ◽  
Crohn Disease ◽  
Clinical Symptoms ◽  
Activity Index ◽  
Severe Disease ◽  
Treatment Options ◽  
Injection Site Reaction ◽  
Perianal Fistula ◽  
Perianal Disease ◽  
Aminosalicylic Acid

Crohn disease (CD) is an inflammatory condition that can affect any portion of the gastrointestinal tract from the mouth to the perianal area. The resulting transmural inflammation can lead to a spectrum of clinical presentations depending on disease location and severity. The treatment of CD depends on the severity of the disease, phenotype, presence of perianal disease, and response to previous therapies. This review examines the goals of therapy for CD, clinical symptoms and disease activity, treatment of disease based on mild to moderate to severe stages, treatment of refractory disease, perianal disease, postoperative CD, and noninflammatory treatment options. Figures show adalimumab injection-site reaction and perianal fistula with seton placement. Tables list the Crohn Disease Activity Index (CDAI), the Harvey Bradshaw Index, 5-aminosalicylic acid formulations, standard dosing of CD medications for moderate to severe disease, and rates of clinical response and remission in patients receiving anti–tumor necrosis factor agents versus placebo, by trial. This review contains 2 highly rendered figures, 5 tables, and 85 references. 

Crohn Disease in Childhood and Adolescence

2018 ◽  
Author(s):  
Lori Zimmerman
Keyword(s):  
Weight Loss ◽  
Gastrointestinal Tract ◽  
Crohn Disease ◽  
Signs And Symptoms ◽  
Mucosal Healing ◽  
Joint Disease ◽  
Perianal Disease ◽  
Childhood And Adolescence ◽  
Chronic Inflammatory Condition ◽  
And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

Crohn Disease in Childhood and Adolescence

2018 ◽  
Author(s):  
Lori Zimmerman
Keyword(s):  
Weight Loss ◽  
Gastrointestinal Tract ◽  
Crohn Disease ◽  
Signs And Symptoms ◽  
Mucosal Healing ◽  
Joint Disease ◽  
Perianal Disease ◽  
Childhood And Adolescence ◽  
Chronic Inflammatory Condition ◽  
And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

Perianal disease

2014 ◽  
pp. 272-272
Author(s):  
Max Pachl ◽  
Michael Hunt ◽  
Girish Jawaheer
Keyword(s):  
Perianal Disease

scholarly journals Predictors of Ustekinumab Failure in Crohn’s Disease After Dose Intensification

2020 ◽  
Author(s):  
Rahul S Dalal ◽  
Cheikh Njie ◽  
Jenna Marcus ◽  
Sanchit Gupta ◽  
Jessica R Allegretti
Keyword(s):  
Logistic Regression ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cox Regression ◽  
Laboratory Data ◽  
Perianal Disease ◽  
Secondary Outcome ◽  
Opioid Use ◽  
Dose Intensification ◽  
Multivariable Logistic Regression

Abstract Background Many patients with Crohn’s disease (CD) who lose response to the standard ustekinumab dose interval of every 8 weeks (q8w) undergo dose intensification to q4w or q6w. However, baseline factors that predict success or failure after dose intensification are unknown. We sought to identify predictors of failure of ustekinumab after dose intensification for patients with CD. Methods This was a retrospective cohort study of adult CD patients undergoing ustekinumab dose intensification at a tertiary referral center between January 1, 2016, and January 31, 2019. Electronic health records were reviewed to obtain patient demographics, CD history, and laboratory data. The primary outcome was failure to achieve corticosteroid-free remission (Harvey-Bradshaw Index &lt;5) within 12 months after intensification. The secondary outcome assessed was time to new biologic therapy after dose intensification. We used multivariable logistic regression and Cox regression to identify predictors of these outcomes. Results We included 123 patients who underwent ustekinumab dose intensification to q4w (n = 64), q5w (n = 1), q6w (n = 55), or q7w (n = 3). Multivariable logistic regression demonstrated that perianal disease, Harvey-Bradshaw Index, and opioid use at time of intensification were associated with failure to achieve remission. Cox regression demonstrated that perianal disease and corticosteroid use at time of intensification were associated with shorter time to a new biologic. Conclusion Perianal disease, Harvey-Bradshaw Index, current opioid use, and current corticosteroid use are associated with ustekinumab failure after dose intensification in CD. Larger, prospective studies are needed to corroborate these findings and guide therapeutic strategies for patients who lose response to standard ustekinumab dosing.

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