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Managing perianal Crohn’s fistula in the anti-TNFα era

  • Challenges in Coloproctology
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Abstract

Perianal fistulas in Crohn’s disease are common and difficult to treat. Their aetiology is poorly understood. Assessment is clinical, endoscopic and radiological, and management is undertaken by a multidisciplinary team of gastroenterologists, surgeons and radiologists. Surgical drainage of the fistula tract system with the placement of loose setons precedes combined therapy with immunosuppressant and anti-TNFα agents in most patients. Proctitis should be rigorously eliminated where possible. Definitive surgical repair is sometimes possible and diversion or proctectomy are occasionally required. Combined medical and surgical management represents a promising avenue for the future.

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Authors and Affiliations

  1. Fistula Research Unit, St Mark’s Hospital, Imperial College London, London, UK

    P. Tozer, A. Gupta, N. Yassin, R. Phillips & A. Hart

  2. University Hospital North Tees, Stockton on Tees, Cleveland, UK

    D. W. Borowski

Authors
  1. P. Tozer
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  2. D. W. Borowski
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  3. A. Gupta
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  4. N. Yassin
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  5. R. Phillips
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  6. A. Hart
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Corresponding author

Correspondence to P. Tozer.

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Conflict of interest

Ailsa Hart has received consulting fees from Abbott Laboratories/AbbVie, Atlantic Healthcare Limited, Bristol Meyers Squibb, Ferring Pharmaceuticals, Shire Pharmaceuticals, Schering Plough Corporation (acquired by Merck), Warner Chilcott UK Limited and Tillotts Pharma. She has received lecture honoraria from Abbott Laboratories/AbbVie, Ferring Pharmaceuticals, Shire Pharmaceuticals, Schering Plough Corporation (acquired by Merck), Warner Chilcott UK Limited. She has received research funding from Abbott Laboratories/AbbVie, Cook Pharmaceutical, MSD. Other authors declared that they have no conflict of interest.

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Tozer, P., Borowski, D.W., Gupta, A. et al. Managing perianal Crohn’s fistula in the anti-TNFα era. Tech Coloproctol 19, 673–678 (2015). https://doi.org/10.1007/s10151-015-1332-3

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  • DOI: https://doi.org/10.1007/s10151-015-1332-3

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