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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 12/2006

01-12-2006

Fistulating Anal Crohn’s Disease: Results of Combined Surgical and Infliximab Treatment

Authors: Syed A. Hyder, F.R.C.S., Simon P. L. Travis, F.R.C.P., Derek P. Jewell, F.R.C.P., Neil J. McC. Mortensen, F.R.C.S., Bruce D. George, F.R.C.S.

Published in: Diseases of the Colon & Rectum | Issue 12/2006

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Introduction

Infliximab is a monoclonal antibody against tumor necrosis factor-alpha, which has been shown to be effective in fistulating Crohn’s disease. The safety of infliximab in patients with potential perianal sepsis is uncertain. This study was designed to assess the safety and outcome of infliximab therapy combined with surgery for patients with fistulating anal Crohn’s disease.

Methods

All patients receiving infliximab for fistulating anal Crohn’s disease between 2000 and 2004 were studied. Patients’ demographics, clinical findings, magnetic resonance imaging, and examination under anesthesia were recorded. Perianal Crohn’s disease activity index before and 8 to 12 weeks after three infusions of infliximab (5 mg/kg) were recorded. Routine policy was to insert drainage seton sutures at the time of preinfliximab examination under anesthesia and then remove it after the second infusion. Complications of treatment and outcome at the last clinic follow-up were recorded.

Results

Twenty-two patients underwent infliximab treatment (6 males; median age, 35 (range, 16–60) years). Twenty-one patients had preinfliximab examination under anesthesia: 12 required abscess drainage; 17 had at least one drainage seton suture inserted. Fourteen patients underwent pretreatment magnetic resonance imaging to identify clinically occult collections. All but one patient were established on immunomodulator therapy before infliximab treatment. Perianal Crohn’s disease activity index improved significantly after infliximab infusion (preinfusion: median, 11, range, 8–17; postinfusion: median, 8, range, 5–16; P< 0.001). There were no serious complications of infliximab treatment. At median follow-up of 21 (range, 4–31) months, only four patients achieved sustained fistula healing. Five patients have required defunctioning or proctectomy. Four patients have required repeated infusions of infliximab.

Conclusions

Infliximab therapy in combination with examination under anesthesia/seton drainage is a safe and effective short-term treatment for fistulating anal Crohn’s disease. Long-term fistula healing rates are low.
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Metadata
Title
Fistulating Anal Crohn’s Disease: Results of Combined Surgical and Infliximab Treatment
Authors
Syed A. Hyder, F.R.C.S.
Simon P. L. Travis, F.R.C.P.
Derek P. Jewell, F.R.C.P.
Neil J. McC. Mortensen, F.R.C.S.
Bruce D. George, F.R.C.S.
Publication date
01-12-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 12/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0656-5

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