How are perianal fistulae managed in Crohn disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Perianal fistulae can be a debilitating complication of Crohn disease. A multidisciplinary and top-down approach may be required to induce remission of more complex fistulae. A small study demonstrated that the combination of ciprofloxacin and metronidazole in 14 patients with perianal fistulae healed the fistulae in 3 patients and improved the condition of 85% of the patients. [120]

There is good evidence that the combination of antibiotics, current medical therapy (anti­­–TNF-α agents with or without azathioprine/6-MP) and surgical drainage of abscesses followed by seton placement is of greatest efficacy in improving the outcome of perianal fistulizing disease. [82]

In addition, the use of endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), or both to identify the anatomy and monitor fistula activity in conjunction with the above-mentioned management approach has been shown to help in the maintenance of fistula closure. [82]

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