VIDEO: Multimodal care, ‘aggressive’ medical treatment a must for perianal Crohn’s disease
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In this Healio video exclusive, Miguel Regueiro, MD, shares highlights from his presentation at the GUILD Conference, where he discussed the importance of early, multimodal intervention in perianal fistulizing Crohn’s disease.
“Firstly, it’s important to recognize perianal Crohn’s disease,” Regueiro, professor of medicine and chief of the Digestive Disease Institute at Cleveland Clinic, told Healio. “A patient who is diagnosed with Crohn’s [with] perianal fistula, abscesses or ulcerations usually has a higher complication rate and a more aggressive course of disease and should be treated earlier.”
According to Regueiro, pelvic MRI is often the modality of choice for diagnosing perianal CD in patients who have pain or bleeding in the area, skin tags, ulcers or visible signs of inflammation. Surgeon involvement also is critical in diagnosing perianal fistula and treating abscesses.
“[Treatment of] perianal Crohn’s disease is really a multimodal approach, meaning we use medications but we also work very closely with our colorectal surgeons,” Regueiro said. “Often in a patient with perianal fistula or concerns about an abscess, we have the surgeon do an exam under anesthesia, drain any infection and place a seton through a fistula before starting medical treatment.”
Studies have shown that this surgery, followed by biologic therapy, has led to better patient outcomes, he noted, adding that the “tried-and-true option” for medically treating perianal CD is a combination of infliximab and a thiopurine, such as azathioprine.
“Even though that is now an old treatment, meaning this has been around for over 20 years, that is probably still the best therapy for perianal fistula in Crohn’s disease after a seton or after the surgeon has drained infection,” he said, noting that recent data also have demonstrated the efficacy of vedolizumab, ustekinumab and upadacitinib in fistula treatment.
“Perianal Crohn’s can have a more aggressive course of disease,” Regueiro said. “But the good news is combining gastroenterologists with surgeons, imaging modalities, looking at surgical interventions, followed by some of our more aggressive medications, we’ve actually now seen better rates of success, healing and response than we’ve ever seen before.”
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Regueiro M. State of the art: Updates in the management perianal Crohn’s disease. Presented at: GUILD Conference; Feb. 18-21, 2024 (hybrid meeting).
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