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Medical-surgical Combined Approach in Perianal Fistulizing Crohn's Disease (CD): Doing it Together

[ Vol. 20 , Issue. 13 ]

Author(s):

Kapil Sahnan*, Samuel O Adegbola, Ana Fareleira, Ailsa Hart and Janindra Warusavitarne   Pages 1373 - 1383 ( 11 )

Abstract:


Fistulising perianal Crohn’s disease (pCD) is an aggressive phenotype, and patients not only suffer from perianal manifestations but also a worsening course for their luminal disease. This article describes the 6 key steps clinicians need to consider when managing patients with pCD which include; (i) ensuring a prompt diagnosis, (ii) multi-disciplinary management, (iii) psychological support, (iv) using multimodal medical and surgical treatment strategies, (v) continually monitoring and optimising therapy and (vi) ensuring that patients have a way of accessing care if required. Patients with fistulising pCD often have an unpredictable disease course and complete remission can be elusive. As such, a considered and nuanced approach is essential keeping the wider multi-disciplinary team and the patient involved in all decision making.

Keywords:

Crohn's disease, perianal, surgery, medical therapy, luminal disease, optimising therapy.

Affiliation:

Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, Centro Hospitalar de Sao Joao, Porto, Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow, Robin Phillips' Fistula Research Unit, St. Mark's Hospital, Harrow

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