Stefan Holubar, MD, on Managing Perianal Crohn Disease

Dr Stefan Holubar reviews his talk on surgical management of perianal Crohn disease from the Advances in Inflammatory Bowel Diseases regional meeting held in Baltimore, Maryland, March 31-April 1.

Stefan Holubar, MD, is IBD surgery section chief and the director of research for the Department of Colorectal Surgery at Cleveland Clinic in Cleveland, Ohio.

TRANSCRIPT:

Hi, I'm Stefan Holubar. I'm the IBD surgery section chief and the director of research for the Department of Colorectal Surgery Cleveland Clinic. I spoke at AIBD Regionals in Baltimore, Maryland on the management of perianal Crohn's disease. We know that, unfortunately, perianal Crohn's disease is pretty common. It affects about 25% of Crohn's patients overall. And about 5% of patients with Crohn's will have isolated perianal Crohn's, meaning it's only affecting the anus, without any intestinal inflammation. We also know and reviewed that perianal Crohn's disease really negatively affects patient's quality of life, and that the best approach to improving their quality of life is using a combined approach of medical and surgical therapy.

The medical therapy typically comprises of TNF inhibitors and an immunomodulator. Surgery typically involves first draining any abscesses, and placing setons to get temporary control of the fistula. And then, making sure the patient's on optimal medical therapy, so that they're not having any active proctitis. And then trying for a local repair, with something such as an anorectal advancement flap or a ligation of the intersphincteric fistula tract, called the LIFT procedure.

There's a variety of different other techniques that we can apply. But unfortunately, about 20% of patients with severe perianal Crohn's disease will have to go on to a proctectomy to give them the best quality of life that they can achieve. One of the pearls that I'm fond of in this particular presentation, is that life with a good ileostomy is better than life with a bad colon, rectum, or anus, or even a bad J-pouch. So that's something that can be reassuring to patients who are facing this kind of surgery.

We did spend a few minutes discussing the state-of-the-art of stem cell therapy for perianal Crohn's disease, which is a super-hot topic right now. We reviewed the short and long-term results of the ADMIRE trial, which is a commercially available allergenic stem cell preparation. And then, we also reviewed all the current available data for a platelet-rich plasma autogenous based stem cell therapy, and also fat or adipose-derived stem cell preparations, which typically involves liposuction and preparation of the stem cell injectate.