Is routine pathological analysis of perianal fistula specimen necessary in diagnosis of crohn's disease?

2020 ◽  
Vol 9 (1) ◽  
pp. 7
Author(s):  
SteveY. C Lau ◽  
CaseyC. H Yu ◽  
SuatC Ng ◽  
Raaj Chandra
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perianal Fistula ◽  
Pathological Analysis

scholarly journals Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1445
Author(s):  
Andromachi Kotsafti ◽  
Melania Scarpa ◽  
Imerio Angriman ◽  
Ignazio Castagliuolo ◽  
Antonino Caruso
Keyword(s):  
Systematic Review ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Hpv Vaccination ◽  
Perianal Fistula ◽  
Hpv Infection ◽  
Poor Quality ◽  
Colorectal Disease ◽  
Small Series ◽  
Chron's Disease

Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn’s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron’s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

scholarly journals Mucinous adenocarcinoma arising from recurrent perianal fistula in patient with Crohn's disease: case report

2014 ◽  
Vol 34 (3) ◽  
pp. 185-188
Author(s):  
Suelene Suassuna Silvestre de Alencar ◽  
Romualdo da Silva Corrêa ◽  
Cátia de França Bezerra ◽  
Marcelo José Carlos Alencar ◽  
Cristiana Soares Nunes ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Crohn's Disease ◽  
Mucinous Adenocarcinoma ◽  
Perianal Fistula ◽  
Disease Case

Systematic Analysis of the Impact of Diagnostic Delay on Bowel Damage in Paediatric Versus Adult Onset Crohn’s Disease

2019 ◽  
Vol 13 (10) ◽  
pp. 1334-1342 ◽  
Author(s):  
Alain Schoepfer ◽  
Jessica Santos ◽  
Nicolas Fournier ◽  
Susanne Schibli ◽  
Johannes Spalinger ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Diagnostic Delay ◽  
Perianal Fistula ◽  
Adult Patients ◽  
Adult Onset ◽  
Systematic Analysis ◽  
Internal Fistula ◽  
The Impact

Abstract Background and Aims Length of diagnostic delay is associated with bowel strictures and intestinal surgery in adult patients with Crohn’s disease [CD]. Here we assessed whether diagnostic delay similarly impacts on the natural history of paediatric CD patients. Methods Data from the Swiss IBD Cohort Study were analysed. Frequency of CD-related complications [bowel stenosis, perianal fistula, internal fistula, any fistula, resection surgery, fistula/abscess surgery, any complication] at diagnosis and in the long term [up to 30 years after CD diagnosis] was compared between paediatric patients [diagnosed <18 years] and adult patients [diagnosed ≥18 years] using multivariate Cox proportional hazard regression modelling. Results From 2006 to 2016, 387 paediatric and 1163 adult CD patients were included. Median [interquartile range: IQR] diagnostic delay was 3 [1–9] for the paediatric and 6 [1–24] months for the adult group, respectively. Adult onset CD patients presented at diagnosis more frequently with bowel stenosis [p <0.001] and bowel surgery [p <0.001] compared with paediatric CD patients. In the long term, length of diagnostic delay was significantly associated with bowel stenosis [p = 0.001], internal fistula [p = 0.038], and any complication [p = 0.024] in the adult onset CD population. No significant association between length of diagnostic delay and CD-related outcomes in the long term was observed in the paediatric population. Conclusions Adult CD patients have longer diagnostic delay compared with paediatric CD patients and present at diagnosis more often with bowel stenosis and surgery. Length of diagnostic delay was found to be predictive for CD-related complications only in the adult but not in the paediatric CD population.

scholarly journals OP12 The incidence and disease course of perianal Crohn’s disease: A Danish nationwide cohort study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S012-S012
Author(s):  
M D Wewer ◽  
M Zhao ◽  
A Nordholm-Carstensen ◽  
J B Seidelin ◽  
J Burisch
Keyword(s):  
Rectal Cancer ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Incidence Rate ◽  
Anal Cancer ◽  
Perianal Fistula ◽  
Disease Course ◽  
Perianal Crohn’S Disease ◽  
Increased Risk ◽  
Perianal Crohn's Disease

Abstract Background Perianal Crohn’s disease (pCD) has a major negative impact on patients’ quality of life and is complex to treat. Despite its putative high frequency and burden for patients, only a few studies have investigated the incidence, disease course and associated cancer-risk in a population-based setting. The aim was to assess the incidence and course of pCD in adult patients with CD within a 19-year period. Specifically, describing changes in medical and surgical management as well as rates of cancer. Methods The cohort comprised all individuals &gt;18 years diagnosed with CD in Denmark between 1 January 1997 and 31 December 2015. Patients were identified in the National Patient Registry. Chi-square test, Mann–Whitney–Wilcoxon test and multivariate Cox regression analysis were used. Results A total of 1,697/9,739 (17%) patients with CD were found to have pCD. Perianal fistulas were the most common manifestation accounting for 943 (56%) cases. The onset of pCD before CD diagnosis occurred in 32%. The overall incidence of pCD was 20/1,000 patient-years. The incidence of pCD remained stable over time. More patients with pCD were treated with immunomodulators (70%) and biologics (35%) than those without pCD (51%, p &lt; 0.001 and 15%, p &lt; 0.001, respectively). Defunctioning stoma was performed in 157/943 (17%) of perianal fistula patients. Stoma formation in relation to resection was performed in 112/943 (12%) of perianal fistula patients. Patients with pCD were found to have a significantly increased risk of undergoing major abdominal surgery compared with patients without pCD (hazard ratio: 1.52, 95% CI: 1.40 to 1.65, p &lt; 0.001). The incidence rate ratios of anal and rectal cancer in pCD patients were 12.46 (95% CI: 5.07 to 30.59, p &lt; 0.001) and 2.41 (95% CI: 1.31 to 4.42, p = 0.003) respectively, when compared with non-IBD matched controls. The incidence rate ratio of anal and rectal cancer in pCD patients was 2.36 (95% CI: 0.86 to 6.50, p = 0.09) and 1.35 (95% CI: 0.68 to 2.68, p = 0.38) respectively, when compared with CD patients without pCD. Conclusion In this nationwide study, 17% of the CD patients developed pCD. The continuing high incidence of pCD suggests a limited disease-modifying effect of biologics. Patients with pCD were at increased risk of undergoing major surgery compared with non-pCD patients. The risk of rectal or anal cancer was increased in patients with pCD compared with non-IBD matched controls. These findings encourage surveillance of rectal and anal cancer.

scholarly journals Identifying perianal fistula complications in pediatric patients with Crohn’s disease using administrative claims

PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0219893 ◽  
Author(s):  
Jeremy Adler ◽  
Hannah K. Jary ◽  
Sally J. Eder ◽  
Shiming Dong ◽  
Emily Brandt ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pediatric Patients ◽  
Perianal Fistula ◽  
Administrative Claims

Injection of freshly collected autologous adipose tissue for treatment of perianal fistula in a patient with Crohn's disease – a video vignette

2019 ◽  
Vol 21 (8) ◽  
pp. 981-982 ◽  
Author(s):  
H. Elfeki ◽  
H. T. Hougaard ◽  
J. Duelund‐Jakobsen ◽  
L. Lundby
Keyword(s):  
Adipose Tissue ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perianal Fistula ◽  
Video Vignette

scholarly journals Emerging treatments for complex perianal fistula in Crohn’s disease

2009 ◽  
Vol 15 (34) ◽  
pp. 4263 ◽  
Author(s):  
Carlos Taxonera ◽  
David A Schwartz ◽  
Damián García-Olmo
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perianal Fistula ◽  
Emerging Treatments

scholarly journals P061 The molecular landscape of perianal fistula in Crohn’s disease: opportunities for new therapeutic approaches

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S165-S165
Author(s):  
G Bislenghi ◽  
B Verstockt ◽  
J Sabino ◽  
C Caenepeel ◽  
S Verstockt ◽  
...  
Keyword(s):  
Gene Expression ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Differential Gene Expression ◽  
Perianal Fistula ◽  
Rectal Mucosa ◽  
Fistula Tract ◽  
Potential Contribution ◽  
Differential Gene ◽  
Molecular Landscape

Abstract Background Perianal Crohn’s disease (CD) is a debilitating condition, often refractory to medical therapy and requiring repetitive surgical interventions. Nonetheless, its pathophysiology is very poorly understood. Hence, we molecularly characterised the fistula tract and compared it to the molecular landscape of its inner rectal orifice. Methods We collected paired surgical biopsies from the fistula tract and the inner rectal fistula orifice in 29 CD patients with draining perianal fistula, requiring surgical examination under anaesthesia. RNA was extracted and single-end RNA sequencing performed using Illumina HiSeq4000. Sequencing data were analysed through differential gene expression (DESeq2) and corrected for the presence of proctitis. A false discovery rate of 0.001 was considered significant. In addition, cellular deconvolution methods (CIBERSORT) were applied to study the cellular composition of the fistula tract. Results Differential gene expression revealed 2701 transcripts being differentially expressed (1727 up, 974 down in fistula) between the fistula tract and the paired rectal mucosa. The top upregulated gene, LBP (fold change [FC]=2858.8, p = 3.6E−13), highlights the potential contribution of the microbiome. LBP has a central role in the innate immune system by binding to bacterial lipopolysaccharides (LPS) and facilitating the affinity between LPS and CD14, with the subsequent release of various cytokines. Several extracellular matrix proteins could be identified within the top 25 of upregulated genes, including MMP13 (FC = 358.8, p = 1.3E−11), ADAM12 (FC = 175.6, p = 1.4E−12), COL1A1 (FC = 77.1, p = 2.7E−10) and COL5A3 (FC = 32.1, p = 1.7E−12), emphasising the intense tissue remodelling going on in the fistula tract. Despite correcting for the confounding effect of proctitis, the fistula tract expressed higher levels of IL6 (FC = 133.1, p = 3.7E−9), TNF(FC = 14.2, p = 4.8E−5), OSM (FC = 24.3, p = 8.9E−5), IL12p40 (FC = 10.0, p = 8.1E−3), integrin α 4 (FC = 4.5, p = 9.3E−3), integrin β 7(FC = 3.8, p = 4.1E−3) but not IL23p19 (FC = 1.2, p = 0.9). Top downregulated genes were linked to the intestinal epithelium, including KRT19 (FC = −489.1, p = 5.5E−17), KRT8 (FC = −324.0, p = 1.1E−16), CEACAM6 (FC=−515.1, p = 4.5E−16) and MUC2 (FC=−795.4, p = 3.0E−15). Cellular deconvolution identified CD4 memory resting T cells (18.5%), M0 macrophages (17%), M2 macrophages (15.2%), neutrophils (9.2%) and plasma cells (7.5%) as the most abundant cells within the fistula tract. Conclusion We molecularly characterised the fistula tract in perianal CD and identified clear biological differences in comparison to the luminal tract, highlighting the potential of new therapeutic targets and cell types driving this debilitating condition.

scholarly journals Higher anti-TNF serum levels are associated with perianal fistula closure in Crohn’s disease patients

2019 ◽  
Vol 54 (4) ◽  
pp. 453-458 ◽  
Author(s):  
Anne S. Strik ◽  
Mark Löwenberg ◽  
Christianne J. Buskens ◽  
Krisztina B. Gecse ◽  
Cyriel I. Ponsioen ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perianal Fistula ◽  
Serum Levels ◽  
Fistula Closure
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