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How are we managing fistulating perianal Crohn’s disease? Results of a national survey of consultant gastroenterologists
  1. Matthew James Lee1,2,
  2. Steven R Brown2,
  3. Nicola S Fearnhead3,
  4. Ailsa Hart4,
  5. Alan J Lobo5
  6. and the PCD Collaborators
  1. 1Department of Oncology and Metabolism, The Medical School, Sheffield, UK
  2. 2Department of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
  3. 3Department of Colorectal Surgery, Cambridge University Hospitals, Cambridge, UK
  4. 4Department of Gastroenterology, St Marks Hospital, London, UK
  5. 5Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
  1. Correspondence to Matthew James Lee, Department of General Surgery, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK; m.j.lee{at}sheffield.ac.uk

Abstract

Objective Fistulating perianal Crohn’s disease represents a significant challenge to both clinicians and patients. This survey set out to describe current practice and variation in the medical management of this condition.

Design A survey was designed by an expert group of gastroenterologists and surgeons with an inflammatory bowel disease (IBD) interest. The questionnaire aimed to capture opinions from consultant gastroenterologists with a UK practice on the management of acutely symptomatic fistula, assessment of a new fistula presentation, medical management strategies and surgical intervention. The survey was piloted at the British Society of Gastroenterology Clinical Research Group meeting, and distributed at UK gastroenterology meetings.

Results There were 111 completed responses (response rate 55%). Following clearance of sepsis, 22.1% of respondents would wait 6 weeks or more before commencing medical therapy. Antibiotics were used by 89.2%, with a variable duration. First-line medical therapy was thiopurine for 48% and antitumour necrosis factor (TNF) for 50% of respondents. These were used in combination by 44.4%. Interval to escalation of therapy (if required) varied from 1 month to a year. Anti-TNF therapies were favoured in deteriorating patients. An IBD multidisciplinary team was accessible to 98%, although only 23.6% routinely discussed these patients. Optimisation strategies for anti-TNF and thiopurines were used by 70% of respondents. Recurrent sepsis, refractory disease and patient choice are indications for surgical referral.

Conclusion These results illustrate the huge variation in practice and lack of consensus among physicians for the optimal medical management of perianal Crohn’s disease. There are gaps in knowledge that require targeted research.

  • crohn’s disease
  • gastrointestinal fistulae
  • health service research

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Footnotes

  • Twitter @wannabehawkeye

  • Contributors All named authors (MJL, AH, NSF, SRB, AJL) were involved in design of the study, collection and analysis of data, and manuscript preparation. The listed collaborators provided feedback on the design of the survey and undertook data collection. All have reviewed the final manuscript.

  • Funding This work has been funded as part of a grant from the Bowel Disease Research Foundation.

  • Competing interests AH has contributed to advisory boards or lectured for AbbVie, MSD, Hospira and Napp Pharmaceuticals. AJL is an advisory board member or received lecture fees from Takeda Pharma, AbbVie, Vifor Pharma, Dr Falk and Shield Therapeutics. The other authors have no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators S Adegbola, T Banerjee, S Elkady, M R Iqbal, G Moran, H Kankam, M Parkes, S Sebastian, A Thind, P Tozer.

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