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The Israel Medical Association Journal... Jun 2007
Topics: Anal Canal; Anus Diseases; Crohn Disease; Humans; Israel; Rectal Fistula
PubMed: 17642408
DOI: No ID Found -
Current Drug Targets Sep 2012Anorectal involvement in Crohn's disease (CD) causes perianal lesions that vary from simple asymptomatic skin tags, to complex disabling fistulas and abscesses. Perianal... (Review)
Review
Anorectal involvement in Crohn's disease (CD) causes perianal lesions that vary from simple asymptomatic skin tags, to complex disabling fistulas and abscesses. Perianal CD affects approximately one-third of patients; its management is challenging and may require combined medical and surgical treatment, which has proven to offer the best chance of success. An optimal preoperative disease assessment is crucial in order to achieve an optimal outcome and avoid irreversible damage due to incomplete or inaccurate intervention. Imaging modalities are useful in order to confirm diagnosis, to accurately classify the disease, as to plan the most suitable treatment and monitor its results. Endoscopic Ultrasonography (EUS) and pelvic Magnetic Resonance (MRI) represent the best options from this perspective, both in terms of sensitivity and specificity, as well as for their demonstrated role in influencing treatment approach. Transperineal Ultrasonography (TPUS) may be helpful when EUS is contraindicated or not-tolerated. Computed Tomography (CT) and fistulography are generally no longer considered due to their inferior performance and the radiation exposure they involve. All imaging should be done in conjunction with an Evaluation Under Anesthesia (EUA) performed by an expert surgeon, to ensure accurate disease assessment. In this paper we review available data on each imaging modality, comparing performance and focusing on specific pros and cons, in order to assist clinicians in choosing the most appropriate treatment option for each individual patient.
Topics: Anus Diseases; Crohn Disease; Humans; Magnetic Resonance Imaging; Radiography
PubMed: 22664086
DOI: 10.2174/138945012802429723 -
Der Internist Oct 2017In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly... (Review)
Review
In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly recognize the cause of the complaints and initiate the appropriate therapy or arrange referral to a proctological institution. This article aims to briefly and succinctly present the most common diseases in proctology (e.g. mariscae, hemorrhoids, anal fissures, perianal venous thrombosis, abscesses and fistulas, condyloma acuminatum and anal carcinoma) and to provide the treating internist, even outside of gastroenterology, assistance with the management of proctological symptoms.
Topics: Abscess; Anal Canal; Anus Diseases; Condylomata Acuminata; Fissure in Ano; Hemorrhoids; Humans; Internal Medicine; Venous Thrombosis
PubMed: 28884323
DOI: 10.1007/s00108-017-0318-9 -
World Journal of Gastroenterology Apr 2011Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal... (Review)
Review
Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.
Topics: Anus Diseases; Clinical Trials as Topic; Crohn Disease; Cytokines; Humans
PubMed: 21528071
DOI: 10.3748/wjg.v17.i15.1939 -
Diseases of the Colon and Rectum Jun 2011
Topics: Abscess; Anus Diseases; Causality; Humans; Incidence; Rectal Fistula; Risk Factors; Smoking; United States; Veterans
PubMed: 21552046
DOI: 10.1007/DCR.0b013e31820ea359 -
Gastroenterology May 2004The medical therapy of Crohn's disease has improved considerably in recent years. In large part, this is due to the introduction of new efficacious agents, both... (Review)
Review
The medical therapy of Crohn's disease has improved considerably in recent years. In large part, this is due to the introduction of new efficacious agents, both "biologics" and traditional small molecules. Further study of older drugs has also advanced our ability to devise the optimum approach to individual Crohn's disease patients by better clarifying the benefits, adverse effects, and means to optimize doses of established medications. In this review, we present an evidence-based approach to the medical management of active Crohn's disease, Crohn's disease in remission, and perianal Crohn's disease that emphasizes recent advances that have come from the results of randomized controlled clinical trials.
Topics: Anus Diseases; Clinical Trials as Topic; Crohn Disease; Gastrointestinal Agents; Humans; Remission Induction
PubMed: 15168368
DOI: 10.1053/j.gastro.2004.01.062 -
The American Journal of Gastroenterology May 1996To review the frequency, severity, course, and outcome of perianal Crohn's disease in children and adolescents. (Review)
Review
OBJECTIVES
To review the frequency, severity, course, and outcome of perianal Crohn's disease in children and adolescents.
METHODS
Records of 141 children and adolescents with Crohn's disease were reviewed. Of these, 18 patients (eight female, 10 male) between 9 and 18 yr of age (nine blacks and nine whites) had significant perianal disease. The disease was classified on the basis external appearance, degree of inflammation, presence of infection or abscess formation, spread to vulva, loss of perineal body, and occurrence of anal canal stricture as being mild, moderate, or severe.
RESULTS
Eight patients had severe involvement, whereas moderate and mild degree of perianal disease was seen in six and four patients, respectively. Disease localization was as follows: pancolitis, 12; ileocolitis, four; and left colitis, two. Therapy with Azulfidine or 5-amino salicylic acid preparation, local and systemic steroids, metronidazole, immunosuppressives, and enteral and/or parenteral nutrition was used in various combinations. Surgery was necessary in eight patients: in four for management of anal canal stricture, incision and drainage of abscess in two, total proctocolectomy in one, and fecal diversion in an additional patient. Over a follow-up period ranging from 18 months to 15 yr, nine patients had partial improvement, whereas in the rest, the disease either did not improve or worsened.
CONCLUSIONS
Severe, mutilating perianal Crohn's disease, causing significant tissue destruction, occurs in both sexes and is extremely refractory to treatment in the majority of patients. The outcome in mild and moderate disease is better.
Topics: Adolescent; Anus Diseases; Child; Child, Preschool; Combined Modality Therapy; Crohn Disease; Female; Humans; Infant; Male; Retrospective Studies; Treatment Outcome
PubMed: 8633582
DOI: No ID Found -
Diseases of the Colon and Rectum Aug 2020
Topics: Anus Diseases; Crohn Disease; Humans; Rectal Fistula
PubMed: 32692068
DOI: 10.1097/DCR.0000000000001747 -
Journal of Crohn's & Colitis Jun 2022
Topics: Anus Diseases; Crohn Disease; Fibrosis; Humans; Magnetic Resonance Imaging; Treatment Outcome
PubMed: 34626172
DOI: 10.1093/ecco-jcc/jjab166 -
Digestive and Liver Disease : Official... Oct 2007Perianal lesions are exceedingly common in Crohn's disease and many patients have more than one type of lesion. Skin tags, fissures and haemorrhoids may persist over... (Review)
Review
Perianal lesions are exceedingly common in Crohn's disease and many patients have more than one type of lesion. Skin tags, fissures and haemorrhoids may persist over time and are usually managed expectantly or with topical therapy. Perianal and rectovaginal fistulas and associated abscesses often require both local and systemic therapy, and recurrence is common. In general, the clinical course of Crohn's disease is more aggressive in patients with perianal involvement. Established risk factors for perianal disease include colonic disease and young age at disease onset. Classification schema now recognize perianal fistulas as distinct from other forms of penetrating Crohn's disease. Genetic susceptibility factors for perianal disease may exist, but they remain incompletely delineated at present. There is hope that immunosuppressive and biotechnology medications will influence the natural history of perianal disease by preventing invasive surgeries, disease complications and recurrence, but this needs to be confirmed. Cancer, a rare complication of perianal disease, must be suspected when lesions persist despite therapy.
Topics: Anus Diseases; Congresses as Topic; Crohn Disease; Diagnosis, Differential; Humans
PubMed: 17720635
DOI: 10.1016/j.dld.2007.07.154