What are guidelines for treating anal fistulas associated with Crohn's disease?

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Consensus guidelines from a working group of the World Congress of Gastroenterology call for a multidisciplinary approach to the management of perianal fistulas associated with Crohn disease. The guidelines list surgical drainage of the abscesses as first-line treatment prior to starting immunosuppressive therapy. Definitive fistula repair with surgical treatment such as fistulotomy, ligation of the intersphincteric fistula tract (LIFT), or the use of mucosal advancement flaps, plugs, or fibrin glue should be considered only if there is no luminal inflammation. The guidelines also state that anti-tumor necrosis factor can provide first-line medical therapy, with an option being to combine this treatment with the use of antibiotics and/or thiopurines. [24]


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