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Burden and outcomes for complex perianal fistulas in Crohn's disease:Systematic review

World Journal of Gastroenterology 2018年第42期24卷 4821-4834页

作者： Julian Panes Walter Reinisch ewa rupniewska Shahnaz Khan Joan Forns Javaria Mona Khalid Daniela Bojic Haridarshan Patel Department of Gastroenterology Hospital Clínic de BarcelonaIDIBAPSCIBERehdBarcelona 08036Spain Medical University of Vienna Vienna 1090Austria RTI Health Solutions Manchester M20 2LSUnited Kingdom RTI Health Solutions Research Triangle ParkNC 27709United States RTI Health Solutions Barcelona 08028Spain Takeda DeerfieldIL 60015United States

AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal *** PubMed, Embase, and Cochrane were searched for relevant articles(published 2000-November 2016) and congress abstracts(published 2011-November 2016).RESULTS Of 535 records reviewed, 62 relevant sources were identified(mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14%(follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment(failure and relapse rates,respectively: medical, 12%-73% and 0%-41%; surgical:0%-100% and 11%.20%; combined medical/surgical:0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies(1 of infliximab; 3 of surgical interventions)have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in *** Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to antitumour necrosis factor-α agents, as evidenced by high failure and relapse rates.

关键词： Burden Complex perianal fistulas Crohn’s disease Epidemiology Outcomes Systematic literature review Treatment

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