BACKGROUND Crohn’s disease(CD)is complicated by perianal fistulas in approximately 20%of patients.Achieving permanent fistula closure remains a challenge for physicians.An association between serum anti-tumor necrosi...BACKGROUND Crohn’s disease(CD)is complicated by perianal fistulas in approximately 20%of patients.Achieving permanent fistula closure remains a challenge for physicians.An association between serum anti-tumor necrosis factor-αconcentrations and clinical outcomes in patients with CD has been demonstrated;however,little information is available on serum adalimumab(ADA)concentrations and remission of perianal fistulas in such patients.AIM To study the relationship between serum ADA concentrations and clinical remission of CDassociated perianal fistulas.METHODS This cross-sectional study of patients with CD-associated perianal fistulas treated with ADA was performed at four French hospitals between December 2013 and March 2018.At the time of each serum ADA concentration measurement,we collected information about the patients and their fistulas.The primary study endpoint was clinical remission of fistulas defined as the absence of drainage(in accordance with Present’s criteria),with a PDAI≤4,absence of a seton and assessment of the overall evaluation as favorable by the proctologist at the relevant center.We also assessed fistula healing[defined as being in clinical and radiological(magnetic resonance imaging,MRI)remission]and adverse events.RESULTS The study cohort comprised 34 patients who underwent 56 evaluations(patients had between one and four evaluations).Fifteen patients had clinical remissions(44%),four of whom had healed fistulas on MRI.Serum ADA concentrations were significantly higher at evaluations in which clinical remission was identified than at evaluations in which it was not[14(10-16)vs 10(2-15)μg/mL,P=0.01].Serum ADA concentrations were comparable at the times of evaluation of patients with and without healed fistulas[11(7-14)vs 10(4-16)μg/mL,P=0.69].The adverse event rate did not differ between different serum ADA concentrations.CONCLUSION We found a significant association between high serum ADA concentrations and clinical remission of CD-associated perianal fistulas.展开更多
Peri-anal fistulae are a worldwide health problem that can affect any person anywhere.Surgical management of these fistulae is not free from risks.Recurrence and fecal incontinence are the most common complications af...Peri-anal fistulae are a worldwide health problem that can affect any person anywhere.Surgical management of these fistulae is not free from risks.Recurrence and fecal incontinence are the most common complications after surgery.The cumulative personal surgical experience in managing cases with anal fistulae is significantly considered as necessary for obtaining better results with minimal adverse effects after surgery.The purpose for conducting this survey is to facilitate better outcome after surgical interventions in idiopathic anal fistulae’ cases.展开更多
Background.Many patients presenting with anal incontinence(AI)are frail,with attendant comorbidities precluding the use of complicated,expensive reconstructive techniques.In these cases,revisiting a simple approach—d...Background.Many patients presenting with anal incontinence(AI)are frail,with attendant comorbidities precluding the use of complicated,expensive reconstructive techniques.In these cases,revisiting a simple approach—designed to provide some sort of effective barrier to stool—is worthwhile where the options include a customized peri-anal sling or the use of an anal plug.Methods.Analysis of an unselected cohort of 33 patients(mean age 54 years;range 27–86 years)with AI is presented,these patients having undergone insertion of an elastic band peri-anal sling between December 2004 and December 2009.Preand post-operative assessment included the Jorge-Wexner score of incontinence,anorectal manometry and the Rockwood Fecal Incontinence Quality of Life(FIQoL)score.Results.The follow-up period ranged from 50 to 108 months with a mean of 65 months.Early post-operative complications included spontaneous disruption of the sling at the fourth and seventh post-operative day in two patients and local infection in a further two cases.Late complications included skin erosion in two patients,(one occurring 3 years post-operatively)and breakage of the sling in a further seven patients.Explantation was performed in 13 cases,and re-implantation in 10 patients.No differences were noted in resting or squeeze manometry,with significant improvement in the Jorge-Wexner scores in 32 cases and in all of the four Rockwood quality of life scales.Conclusions.An anal sling is an effective and simple surgical option for the management of selected cases presenting with anal incontinence.Longer-term data are awaited comparing this technique with other standard surgical alternatives.展开更多
基金Supported by the Assistance Publique des H?pitaux de Paris and AbbVie (North Chicago, Illinois, United States)
文摘BACKGROUND Crohn’s disease(CD)is complicated by perianal fistulas in approximately 20%of patients.Achieving permanent fistula closure remains a challenge for physicians.An association between serum anti-tumor necrosis factor-αconcentrations and clinical outcomes in patients with CD has been demonstrated;however,little information is available on serum adalimumab(ADA)concentrations and remission of perianal fistulas in such patients.AIM To study the relationship between serum ADA concentrations and clinical remission of CDassociated perianal fistulas.METHODS This cross-sectional study of patients with CD-associated perianal fistulas treated with ADA was performed at four French hospitals between December 2013 and March 2018.At the time of each serum ADA concentration measurement,we collected information about the patients and their fistulas.The primary study endpoint was clinical remission of fistulas defined as the absence of drainage(in accordance with Present’s criteria),with a PDAI≤4,absence of a seton and assessment of the overall evaluation as favorable by the proctologist at the relevant center.We also assessed fistula healing[defined as being in clinical and radiological(magnetic resonance imaging,MRI)remission]and adverse events.RESULTS The study cohort comprised 34 patients who underwent 56 evaluations(patients had between one and four evaluations).Fifteen patients had clinical remissions(44%),four of whom had healed fistulas on MRI.Serum ADA concentrations were significantly higher at evaluations in which clinical remission was identified than at evaluations in which it was not[14(10-16)vs 10(2-15)μg/mL,P=0.01].Serum ADA concentrations were comparable at the times of evaluation of patients with and without healed fistulas[11(7-14)vs 10(4-16)μg/mL,P=0.69].The adverse event rate did not differ between different serum ADA concentrations.CONCLUSION We found a significant association between high serum ADA concentrations and clinical remission of CD-associated perianal fistulas.
文摘Peri-anal fistulae are a worldwide health problem that can affect any person anywhere.Surgical management of these fistulae is not free from risks.Recurrence and fecal incontinence are the most common complications after surgery.The cumulative personal surgical experience in managing cases with anal fistulae is significantly considered as necessary for obtaining better results with minimal adverse effects after surgery.The purpose for conducting this survey is to facilitate better outcome after surgical interventions in idiopathic anal fistulae’ cases.
文摘Background.Many patients presenting with anal incontinence(AI)are frail,with attendant comorbidities precluding the use of complicated,expensive reconstructive techniques.In these cases,revisiting a simple approach—designed to provide some sort of effective barrier to stool—is worthwhile where the options include a customized peri-anal sling or the use of an anal plug.Methods.Analysis of an unselected cohort of 33 patients(mean age 54 years;range 27–86 years)with AI is presented,these patients having undergone insertion of an elastic band peri-anal sling between December 2004 and December 2009.Preand post-operative assessment included the Jorge-Wexner score of incontinence,anorectal manometry and the Rockwood Fecal Incontinence Quality of Life(FIQoL)score.Results.The follow-up period ranged from 50 to 108 months with a mean of 65 months.Early post-operative complications included spontaneous disruption of the sling at the fourth and seventh post-operative day in two patients and local infection in a further two cases.Late complications included skin erosion in two patients,(one occurring 3 years post-operatively)and breakage of the sling in a further seven patients.Explantation was performed in 13 cases,and re-implantation in 10 patients.No differences were noted in resting or squeeze manometry,with significant improvement in the Jorge-Wexner scores in 32 cases and in all of the four Rockwood quality of life scales.Conclusions.An anal sling is an effective and simple surgical option for the management of selected cases presenting with anal incontinence.Longer-term data are awaited comparing this technique with other standard surgical alternatives.
