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Medical Treatment of Perianal Crohn Disease Fistulae

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Pediatric Inflammatory Bowel Disease

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Abstract

The treatment of perianal fistulizing Crohn’s disease has evolved substantially in the last 15 years, primarily due to improvements in medical therapy. The efficacy of immunomodulators and anti-TNF-α agents has transformed the treatment of Crohn’s fistulae from almost exclusively surgical to placing a much larger emphasis on medical therapy, either as initial therapy alone (with surgery reserved for refractory cases) or in combination with surgery from the onset. Proper fistula management also relies heavily on accurate diagnosis, especially defining fistula anatomy and determining whether abscesses and rectal inflammation are present. This review will discuss the diagnosis, classification, and medical management of perianal Crohn’s fistulae.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, 218 Wright Saunders Building, 51N. 39th Street, Philadelphia, PA, 19104, USA

    Mark T. Osterman MD, MSCE

  2. Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 3400 Spruce Street, 9 Penn Tower, Philadelphia, PA, 19104, USA

    Gary R. Lichtenstein MD

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  1. Mark T. Osterman MD, MSCE
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Correspondence to Gary R. Lichtenstein MD .

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Editors and Affiliations

  1. Perelman School of Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Petar Mamula

  2. School of Medicine--Greenville, Pediatric Gastroenterology & Nutrition, University of South Carolina, 200 Patewood Drive, Suite A-140, Greenville, 29615, South Carolina, USA

    Jonathan E. Markowitz

  3. Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Robert N. Baldassano

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Osterman, M.T., Lichtenstein, G.R. (2013). Medical Treatment of Perianal Crohn Disease Fistulae. In: Mamula, P., Markowitz, J., Baldassano, R. (eds) Pediatric Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5061-0_35

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