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Review Article

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

Author(s): Kapil Sahnan*, Samuel O Adegbola, Ana Fareleira, Ailsa Hart and Janindra Warusavitarne

Volume 20, Issue 13, 2019

Page: [1373 - 1383] Pages: 11

DOI: 10.2174/1389450120666190520103454

Price: $65

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.

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Graphical Abstract

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