Treatment of fistulizing Crohn’s disease in children
- 40 Downloads
Patients with Crohn’s disease are at risk for developing both internal and external fistulae. These can be asymptomatic incidental radiologic findings or causes of incontinence, chronic pain, abscesses, and sepsis. They can have a devastating impact on quality of life. Careful prospective studies of therapy are few in adult medicine and entirely lacking in the pediatric age group. Assessment and management require a coordinated effort between gastroenterologist, radiologist, and surgeon. Principles of management include surgical drainage of infection combined with medical therapy. Only infliximab has been studied in prospective, double-blinded fashion and clearly shown to be of use in the short term. There is good evidence that metronidazole may be useful acutely and that 6-mercaptopurine azathioprine may help to maintain closure. Diverting ostomies are of very limited value and corticosteroids seem to make matters worse. There are many other therapies that have been reported to be helpful in small, uncontrolled studies.
KeywordsInfliximab Main Side Effect Main Drug Interaction Anal Fistula Rectovaginal Fistula
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 5.Griffiths AM, Buller HB: Inflammatory bowel disease. In Pediatric Gastrointestinal Diseases, edn 3. Edited by Walker WA. Hamilton, Ontario: BC Decker; 2000:613–652.Google Scholar
- 9.Schwartz DA, Wiersema MJ, Dudiak KM, et al.: A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 2001, 121:1064–1072. A meticulous study comparing different diagnostic modalities in the work-up of fistulizing Crohn’s disease.PubMedCrossRefGoogle Scholar
- 11.Stewart LK, McGee J, Wilson SR: Transperineal and transvaginal sonography of perianal inflammatory disease. Am J Radiol 2001, 177:627–632.Google Scholar
- 28.Simoneaux SF, Patrick LE: Genitourinary complications of Crohn’s disease in pediatric patients. Am J Roentgenol 1997, 169:197–199.Google Scholar
- 31.Turunen U, Farkkila M, Seppala K: Long-term treatment of perianal or fistulous crohn’s disease with ciprofloxacin. Scand J Gastroenterol 1989, 24(suppl 148):144.Google Scholar
- 33.Muhadevan UJ, Marion R, Present DH: The place of methotrexate in the treatment of refractory Crohn’s disease. Gastroenterology 1997, 112:A2031.Google Scholar
- 48.Practice parameters for treatment of fistula-in-anosupporting documentation. The Standards Practice Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 1996, 39:1363–1372.Google Scholar