Ribaldone Davide G, Resegotti Andrea, Pellicano Rinaldo, Astegiano Marco, Saracco Giorgio M, Morino Mario
Department of Surgical Sciences, University of Turin, Turin, Italy -
General Surgery 1 U, Città della Salute e della Scienza, Turin, Italy.
Minerva Gastroenterol Dietol. 2019 Jun;65(2):130-135. doi: 10.23736/S1121-421X.19.02565-0. Epub 2019 Feb 12.
Rectal inflammation is the principal risk factor for the development of perianal fistulizing Crohn's disease. However, no topical therapy direct to rectal healing is discussed in European' guidelines. The aim of this systematic review was to evaluate the role of topical therapy in healing the rectal inflammation in Crohn's disease.
A MEDLINE search of all studies published in English until December 2018 was conducted. Articles were identified using the strings "Crohn's disease and topical therapy" or "perianal Crohn's disease and topical therapy."
Contradictory results about the efficacy of topical metronidazole were present. No benefit from topical tacrolimus use was demonstrated. Mesalazine suppositories induced and maintained remission of rectal inflammation in 50% of patients with rectal Crohn's disease. Few data were available about the role of local therapy for the fistulous tract in Crohn's disease. Local mesenchymal stem cells therapy could be a promising new approach.
Due to the disappoint success rate of current strategy in perianal fistulizing Crohn's disease, the role of rectal inflammation as a causative factor and the fair success rate of topical therapy with mesalazine suppositories in the healing of rectal inflammation without relevant side effects, more studies are advisable in this field.
直肠炎症是肛周瘘管性克罗恩病发生的主要危险因素。然而，欧洲指南中未讨论针对直肠愈合的局部治疗方法。本系统评价的目的是评估局部治疗在克罗恩病直肠炎症愈合中的作用。
对截至2018年12月以英文发表的所有研究进行了MEDLINE检索。使用“克罗恩病和局部治疗”或“肛周克罗恩病和局部治疗”等检索词来识别文章。
关于局部使用甲硝唑的疗效存在矛盾的结果。未证明局部使用他克莫司有获益。美沙拉嗪栓剂可使50%的直肠克罗恩病患者诱导并维持直肠炎症缓解。关于局部治疗在克罗恩病瘘管中的作用，可用数据较少。局部间充质干细胞治疗可能是一种有前景的新方法。
鉴于目前治疗肛周瘘管性克罗恩病的策略成功率令人失望，直肠炎症作为病因的作用以及美沙拉嗪栓剂局部治疗在直肠炎症愈合中具有良好成功率且无相关副作用，该领域建议开展更多研究。
