Review
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 14, 2009; 15(34): 4263-4272
Published online Sep 14, 2009. doi: 10.3748/wjg.15.4263
Emerging treatments for complex perianal fistula in Crohn’s disease
Carlos Taxonera, David A Schwartz, Damián García-Olmo
Carlos Taxonera, Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico, Madrid 28040, Spain
David A Schwartz, Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville 37232, TN, United States
Damián García-Olmo, Department of General Surgery, “La Paz” University Hospital, Madrid 28046, Spain
Author contributions: Taxonera C, Schwartz DA and García-Olmo D all contributed to this paper.
Correspondence to: Carlos Taxonera, MD, PhD, Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico, Prof. Martín Lagos s/n, Madrid 28040, Spain. ctaxonera.hcsc@salud.madrid.org
Telephone: +34-91-3303049 Fax: +34-91-3303785
Received: April 12, 2009
Revised: August 12, 2009
Accepted: August 19, 2009
Published online: September 14, 2009
Abstract

Complex perianal fistulas have a negative impact on the quality of life of sufferers and should be treated. Correct diagnosis, characterization and classification of the fistulas are essential to optimize treatment. Nevertheless, in the case of patients whose fistulas are associated with Crohn’s disease, complete closure is particularly difficult to achieve. Systemic medical treatments (antibiotics, thiopurines and other immunomodulatory agents, and, more recently, anti-tumor necrosis factor-α agents such as infliximab) have been tried with varying degrees of success. Combined medical (including infliximab) and less aggressive surgical therapy (drainage and seton placement) offer the best outcomes in complex Crohn’s fistulas while more aggressive surgical procedures such as fistulotomy or fistulectomy may increase the risk of incontinence. This review will focus on emerging novel treatments for perianal disease in Crohn’s patients. These include locally applied infliximab or tacrolimus, fistula plugs, instillation of fibrin glue and the use of adult expanded adipose-derived stem cell injection. More well-designed controlled studies are required to confirm the effectiveness of these emerging treatments.

Keywords: Crohn’s disease; Perianal fistula; Drug therapy; Topical administration; Infliximab; Adalimumab; Adipose tissue; Stem cells