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thiopurines crohn fistula

Geeta Shroff
BACKGROUND: Crohn's disease is a chronic inflammatory disease of the intestines, mainly the colon and ileum, related with ulcers and fistulae. It is estimated to affect 565,000 people in the United States. Currently available therapies, such as antibiotics, thiopurines, and anti-tumor necrosis factor-alpha agents, are only observed to reduce the complications associated with Crohn's disease and to improve quality of life, but cannot cure the disease. Stem cell therapy appears to have certain advantages over conventional therapies...
2016: American Journal of Case Reports
Kurt G Davis
Crohn's disease of the foregut is more common than previously recognized, with up to 40% of patients with Crohn's disease in the distal intestine also having evidence of foregut disease. Esophageal disease is best managed medically with proton pump inhibition, steroids, thiopurines, methotrexate, and anti-tumor necrosis factor-α biologic medications. Esophageal strictures are dealt with using endoscopic dilation. Surgery is generally reserved of resistant strictures or esophageal fistulas. Patients with gastroduodenal disease more commonly come to surgery...
December 2015: Surgical Clinics of North America
Thomas Klag, Martin Goetz, Eduard F Stange, Jan Wehkamp
BACKGROUND: Development of perianal fistulas are a common feature of Crohn's disease (CD). Consequences are severe impairment of quality of life as well as potentially life-threatening complications like abscess formation or bacterial sepsis. Therefore, appropriate treatment is an important task in the management of CD. METHODS: This review describes the epidemiology, pathogenesis, diagnosis, and conservative medical treatment of perianal CD with regard to the available literature...
August 2015: Viszeralmedizin
Pierre Michetti
Crohn's disease (CD) evolution is characterized by increasing proportions of patients developing complications such as strictures, abscesses and fistulas that require surgical management. After resection of a diseased intestinal segment, CD recurrence concerns up to 60% of patients within a year post surgery. The mucosa just above the site of the intestinal anastomosis is at particularly high risk of relapse. Prophylactic medical therapy to prevent recurrence has been shown to be effective with a variety of medications, but the recurrence rate remains high, demanding that a better risk stratification of patients be achieved...
September 14, 2015: Digestive Diseases
Caroline Klotz, Marion Dhooge, Ammar Oudjit, Maximilien Barret, Frédéric Beuvon, Stanislas Chaussade, Romain Coriat, Vered Abitbol
Crohn's disease is an inflammatory bowel disease that affects the entire digestive tract, from the mouth to the anus. The inflammatory disease is transmural and may be complicated by abscesses, fistulas, strictures. Budesonide is used as first-line treatment for a first episode of ileitis. Thiopurines and methotrexate are used as immunosuppressive maintenance therapy. Anti-tumour necrosis factors (TNF) alpha therapy is used as induction and maintenance therapy in case of severe flares or corticodependence. Combination of immunosuppressive therapy and anti-TNF-alpha (combotherapy) prevents the appearance of specific anti drug antibodies...
April 2015: La Presse Médicale
Krisztina B Gecse, Willem Bemelman, Michael A Kamm, Jaap Stoker, Reena Khanna, Siew C Ng, Julián Panés, Gert van Assche, Zhanju Liu, Ailsa Hart, Barrett G Levesque, Geert D'Haens
OBJECTIVE: To develop a consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease (pCD), based on best available evidence. METHODS: Based on a systematic literature review, statements were formed, discussed and approved in multiple rounds by the 20 working group participants. Consensus was defined as at least 80% agreement among voters. Evidence was assessed using the modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria...
September 2014: Gut
Angelo V Marzano, Alessandro Borghi, Antoni Stadnicki, Carlo Crosti, Massimo Cugno
The skin is one of the most common extraintestinal organ system affected in patients with inflammatory bowel disease (IBD), including both Crohn's disease and ulcerative colitis. The skin manifestations associated with IBD are polymorphic and can be classified into 4 categories according to their pathophysiology: (1) specific, (2) reactive, (3) associated, and (4) induced by IBD treatment. Cutaneous manifestations are regarded as specific if they share with IBD the same granulomatous histopathological pattern: perianal or metastatic Crohn's disease (commonly presenting with abscesses, fistulas or hidradenitis suppurativa-like features) is the prototype of this setting...
January 2014: Inflammatory Bowel Diseases
Sebastian Strobel, Maria T Abreu
PURPOSE OF REVIEW: This article summarizes the latest developments for three types of idiopathic colitis: ulcerative colitis, Crohn's disease, and microscopic colitis. RECENT FINDINGS: Crohn's disease and ulcerative colitis are highly related genetically. Colonoscopy remains the gold standard for making a diagnosis. The addition of chromoendoscopy can aid in identification and removal of colonic dysplasia in both disorders. The therapy for ulcerative colitis and Crohn's disease has been transformed with the introduction of anti-TNF treatment...
January 2013: Current Opinion in Gastroenterology
Fernando Bermejo, Elena Garrido, María Chaparro, Jordi Gordillo, Miriam Mañosa, Alicia Algaba, Antonio López-Sanromán, Javier P Gisbert, Esther García-Planella, Iván Guerra, Eugeni Domènech
BACKGROUND: Management of abdominal abscesses (AA) in Crohn's disease (CD) always includes antibiotics, and some type of drainage is added according to the response and other considerations. Our aim was to assess the efficacy of different therapeutic approaches to spontaneous AA in CD. METHODS: All cases of AA in CD were identified from the databases of five university hospitals. Postoperative cases were excluded. Therapeutic success was defined as abscess resolution and nonreappearance within 1 year of follow-up...
August 2012: Inflammatory Bowel Diseases
Gema de la Poza, Antonio López-Sanroman, Carlos Taxonera, Ignacio Marín-Jimenez, Javier P Gisbert, Fernando Bermejo, Verónica Opio, Alfonso Muriel
BACKGROUND: Genital fistulas (GF) can arise in the course of Crohn's disease (CD), are difficult to manage and determine a significant alteration of the quality of life. AIMS: To review the joint experience of the Inflammatory Bowel Disease Units in six University Hospitals in the management of GF in Crohn's disease on female patients. RESULTS: A total of 47 patients with GF were identified, affecting 3.8% of women with CD treated in our centers...
April 2012: Journal of Crohn's & Colitis
Livia Biancone, Sara Zuzzi, Micaela Ranieri, Carmelina Petruzziello, Emma Calabrese, Sara Onali, Marta Ascolani, Francesca Zorzi, Giovanna Condino, Simona Iacobelli, Francesco Pallone
BACKGROUND & AIMS: The combined role of immunomodulators (IMM) and clinical characteristics of Inflammatory Bowel Disease (IBD) in determining the cancer risk is undefined. The aim was to assess whether clinical characteristics of IBD are independent risk factors for cancer, when considering thiopurines and anti-TNFs use. METHODS: In a single-center cohort study, clinical characteristics of IBD patients with IBD duration ≥1 year and ≥2 visits from 2000 to 2009 were considered...
June 2012: Journal of Crohn's & Colitis
Phil Tozer, Siew C Ng, Muhammed R Siddiqui, Sophie Plamondon, David Burling, Arun Gupta, Anna Swatton, Sherrill Tripoli, Carolynne J Vaizey, Michael A Kamm, Robin Phillips, Ailsa Hart
BACKGROUND: Anti-tumor necrosis factor (TNF) therapy heals many Crohn's disease (CD) anal fistulas clinically but the rate, extent, and durability of deep tissue healing and factors influencing long-term outcome are unknown. METHODS: Consecutive patients with CD-related perianal (anal, rectovaginal, anolabial) fistulas treated with infliximab or adalimumab were monitored prospectively both clinically and radiologically using magnetic resonance imaging (MRI). RESULTS: Forty-one consecutive patients with CD-related perianal fistulas were treated with infliximab (n = 32) or adalimumab (n = 9; following infliximab failure) in combination with a thiopurine (unless intolerant)...
October 2012: Inflammatory Bowel Diseases
Jacques Cosnes
Ulcerative colitis and Crohn's disease are chronic disabling lifelong diseases which may be disturbed by severe flares and anatomical complications requiring surgery. Until the very last years there was no clear indication that treatment was able to modify the long-term natural history of the disease. In particular, there are no data demonstrating a clear improvement through the period 1950-2003 in disease activity, occurrence of complications and need for surgery, in spite of an increased use of immunosuppressants since the 1990s...
2009: Digestive Diseases
Carlos Taxonera, David A Schwartz, Damián García-Olmo
Complex perianal fistulas have a negative impact on the quality of life of sufferers and should be treated. Correct diagnosis, characterization and classification of the fistulas are essential to optimize treatment. Nevertheless, in the case of patients whose fistulas are associated with Crohn's disease, complete closure is particularly difficult to achieve. Systemic medical treatments (antibiotics, thiopurines and other immunomodulatory agents, and, more recently, anti-tumor necrosis factor-alpha agents such as infliximab) have been tried with varying degrees of success...
September 14, 2009: World Journal of Gastroenterology: WJG
Marc Ferrante, Geert D'Haens, Olivier Dewit, Filip Baert, Jan Holvoet, Karel Geboes, Gert De Hertogh, Gert Van Assche, Séverine Vermeire, Paul Rutgeerts et al.
BACKGROUND: Up to 25% of inflammatory bowel disease (IBD) patients undergoing surgery with an ileal pouch-anal anastomosis (IPAA) will develop chronic pouchitis not responding to antibiotics. In case reports, thiopurine analogs and infliximab (IFX) have been proposed as effective therapy in this setting. We analyzed the long-term efficacy of IFX in Belgian patients with refractory pouch complications. METHODS: We identified 28 IPAA patients who received IFX for refractory luminal inflammation (pouchitis and/or pre-pouch ileitis, n = 25) and/or pouch fistula (n = 7)...
February 2010: Inflammatory Bowel Diseases
María Josefina Etchevers, Montserrat Aceituno, Miquel Sans
Inflammatory bowel disease (IBD) includes two entities, Crohn's disease and ulcerative colitis. Both are chronic conditions with frequent complications and surgical procedures and a great impact on patient's quality of life. The thiopurine antimetabolites azathioprine and 6-mercaptopurine are widely used in IBD patients. Current indications include maintenance therapy, steroid-dependent disease, fistula closure, prevention of infliximab immunogenicity and prevention of Crohn's disease recurrence. Surprisingly, the wide use of immunosuppressants in the last decades has not decreased the need of surgery, probably because these treatments are introduced at too late stages in disease course...
September 28, 2008: World Journal of Gastroenterology: WJG
Azhar Ansari, Tim Elliott, Farina Fong, Monica Arenas-Hernandez, Giles Rottenberg, Bernard Portmann, Sebastian Lucas, Anthony Marinaki, Jeremy Sanderson
BACKGROUND: 6-Thioguanine (6-TG) is efficacious in patients with Crohn's Disease (CD) failing conventional immunosuppression but there are reports of hepatotoxicity. We report our experience of the safety and efficacy of 6-TG in a series of patients with CD. METHODS: A retrospective study of patients with CD who failed thiopurines +/- methotrexate between 2001 and 2006 was performed. Indications for 6-TG were; active disease, to allow infliximab withdrawal, steroid sparing, or fistula closure...
October 2008: Inflammatory Bowel Diseases
Su Yang Soon, Azhar Ansari, May Yaneza, Shariqa Raoof, Jo Hirst, Jeremy D Sanderson
BACKGROUND: Thiopurine drugs (azathioprine and 6-mercaptopurine) are well established in the treatment of patients with inflammatory bowel disease. However, some patients are intolerant or resistant to thiopurine drugs and their management remains a challenge. Several studies have suggested methotrexate is effective for the induction and maintenance of remission in Crohn's disease. OBJECTIVE: This study was conducted because the overall data on clinical efficacy of methotrexate in inflammatory bowel disease remain limited and there are no data regarding fistulating Crohn's disease or concomitant use of methotrexate with thiopurine drugs in inflammatory bowel disease...
September 2004: European Journal of Gastroenterology & Hepatology
C Dejaco, M Harrer, T Waldhoer, W Miehsler, H Vogelsang, W Reinisch
BACKGROUND: Antibiotics and thiopurines have been employed in the management of fistulizing Crohn's disease, although evidence of their efficacy is rare. AIM: To evaluate, in a prospective, open-label study, the influence of antibiotics and azathioprine on the clinical outcome of perianal fistulas in patients with Crohn's disease. METHODS: Fifty-two patients entered the study, starting with an 8-week regimen of ciprofloxacin (500-1000 mg/day) and/or metronidazole (1000-1500 mg/day)...
December 2003: Alimentary Pharmacology & Therapeutics
James F Markowitz
The purine analogues 6-mercaptopurine (6-MP) and azathioprine have been found to be safe and efficacious in both inducing remission of Crohn's disease in adults and maintaining remission in adults and children. In addition, steroid-sparing effects are demonstrable in trials of both adults and children with Crohn's disease. Anecdotal reports of adults and very limited data from children also suggest that azathioprine and 6-MP might help prevent postoperative recurrence of Crohn's disease. Regarding safety, adults and children reported similar rates of adverse effects from the use of these agents: reported adverse effects in adults included significant infection (7...
2003: Reviews in Gastroenterological Disorders
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