Combined therapy with infliximab and seton for perianal fistulising inflammatory bowel diseases (IBD)
World J Surg Oncol. 2014 Jul 16;12:217. doi: 10.1186/1477-7819-12-217.
L. Guidi, I. De Vitis, S. Semeraro, C. Ratto, I. Roberto, F. Faustini, A. Papa, R. Urgesi, G. Gasbarrini and G. Fedeli.
Medicina Interna, Università Cattolica Sacro Cuore, Largo A. Gemelli, 8, Rome, Italy
Healing of the skin before the closure of perianal fistulas has been shown after infliximab treatment in Crohn’s disease CD. Setons could reduce the abscess risk in these patients. Aim of this study is to evaluate the efficacy of the treatment with infliximab and setons for complex perianal fistulas in IBD and to define the optimal time for scton removal by endosonography.
MATERIAL AND METHODS: Ten 1BD patients with complex perianal fistulas received infliximab plus azathioprine. Eight had CD and two pouchitis after colectoiny for ulcerative colitis. Pcrianal sepsis was eradicated when necessary and setons were placed before inflix-imab therapy. Sctons were removed after evidence of fistulous tracts healing at endosonographic examination.
RESULTS: At 6 weeks all CD patients had a partial response of pen-anal disease disease and the mean PDAI score decreased from 10.75 to 4.75. Complete response was achieved in all patients (8/8) after a median time for endosonographic healing and subsequent seton removal at 28 weeks. 7/8 patients maintained the response with a mean follow up of 39.8 weeks. The 2 patients with pouchitis showed no response of perianal disease.
CONCLUSIONS: Combined therapy with infliximab and setons with endosonographic control showed high efficacy in the management of CD patients with complex perianal fistulas.