Management of patients with complex perianal fistulas in Crohn's disease: Optimal patient flow in the Italian clinical reality |
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Affiliation: | 1. Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy;2. Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy;3. IBD Unit, A. Gemelli Hospital, Cattolica University, Rome, Italy;4. Gastroenterology Unit, Department of Medicine, G.B. Rossi University Hospital, Verona, Italy;5. IBD Center, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy;6. Emilia-Romagna IBD Regional Referral Center, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy;7. Surgery Unit, Department of Public Health, Federico II University Hospital, Naples, Italy;8. IBD Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy;9. Gastroenterology Unit, Federico II University Hospital, Naples, Italy;10. Abdominal SUrgery Unit, Department of Gastroenterology, Endocrine-metabolic and Nephrourological Science, A. Gemelli Hospital, Cattolica University, Rome, Italy;11. Unit of General and Oncological Surgery, Department of Surgery, “Villa Sofia-Cervello” Hospital, Palermo, Italy;12. Digestive Surgery Department, S. Orsola-Malpighi University Hospital, Bologna, Italy |
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Abstract: | Perianal fistulizing Crohn’s disease (PFCD) is a common, disabling and aggressive phenotype that negatively impacts on the quality of life of affected patients. Its successful treatment is still a struggle for both physicians and patients. Significant advances in the management of this condition have occurred in the last two decades holding promise for a better future. This culminated into the concept of a collaborative multidisciplinary approach using the latest medical therapies combined with modern surgical and endoscopic techniques. Despite this, PFCD management and treatment have not been standardized yet. Thus the gastroenterologist and surgeon have to be familiar with several approaches and/or techniques. The positioning of each therapeutic option will certainly evolve with new data, but for the time being it should be driven by patient’s characteristics, physician’s preference and/or experience, costs and availability in local practice. Additionally, patient’s perception of benefits and risks of treatment may differ from those of physicians and recognition of this difference is a starting point for difficult clinical decision-making.In this paper, a multidisciplinary group of Italian IBD experts explore and discuss current medical and surgical therapeutic options, highlighting areas of unmet needs in PFCD, with particular focus on the optimal patient flow within the Italian clinical reality. |
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Keywords: | Crohn’s disease Management Medical treatment New therapies Perianal fistulas Surgical treatment Stem cells |
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