Management of perianal fistulas in Crohn&rsquo;s disease: An up-to-date review

doi:10.3748/wjg.v21.i5.1394

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Feb 7, 2015; 21(5): 1394-1403
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1394

Management of perianal fistulas in Crohn’s disease: An up-to-date review

Manuela Marzo, Carla Felice, Daniela Pugliese, Gianluca Andrisani, Giammarco Mocci, Alessandro Armuzzi, Luisa Guidi

Manuela Marzo, Carla Felice, Daniela Pugliese, Gianluca Andrisani, Giammarco Mocci, Alessandro Armuzzi, Luisa Guidi, IBD Unit, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy

Author contributions: Marzo M and Guidi L designed the study and wrote the manuscript; Felice C, Pugliese D, Andrisani G, Mocci G and Armuzzi A provided critical revision to the manuscript.

Conflict-of-interest: All authors declare no conflict-of-interest related to this paper.

Correspondence to: Luisa Guidi, MD, PhD, IBD Unit, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, via Moscati 31, 00168 Rome, Italy. lguidi@rm.unicatt.it

Telephone: +39-6-3503310 Fax: +39-6-3054641

Received: September 9, 2014
Peer-review started: September 9, 2014
First decision: October 29, 2014
Revised: November 17, 2014
Accepted: December 10, 2014
Article in press: December 10, 2014
Published online: February 7, 2015
Processing time: 153 Days and 15.3 Hours

Abstract

Perianal disease is one of the most disabling manifestations of Crohn’s disease. A multidisciplinary approach of gastroenterologist, colorectal surgeon and radiologist is necessary for its management. A correct diagnosis, based on endoscopy, magnetic resonance imaging, endoanal ultrasound and examination under anesthesia, is crucial for perianal fistula treatment. Available medical and surgical therapies are discussed in this review, including new local treatment modalities that are under investigation.

Keywords: Crohn’s disease; Perianal fistula; Surgery; Drug therapy; Tumor necrosis factor alpha

Core tip: Combined medical and surgical treatments are needed to treat perianal Crohn’s disease, after a correct diagnosis.