Wetwittayakhlang Panu, Al Khoury Alex, Hahn Gustavo Drügg, Lakatos Peter Laszlo
Division of Gastroenterology, McGill University Health Center, Montreal, QC H3G 1A4, Canada.
Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
J Clin Med. 2022 May 28;11(11):3045. doi: 10.3390/jcm11113045.
Fistulizing Crohn's disease (FCD) remains the most challenging aspect of treating patients with CD. FCD can occur in up to 30% of patients with CD and may lead to significant disability and impaired quality of life. The optimal treatment strategies for FCD require a multidisciplinary approach, including a combined medical and surgical approach. The therapeutic options for FCD are limited due to sparse evidence from randomized clinical trials (RCTs). The current recommendations are mainly based on post hoc analysis from RCTs, real-world clinical studies and expert opinion. There is variation in everyday clinical practice amongst gastroenterologists and surgeons. The evidence for anti-tumor necrosis factor therapy is the strongest in the treatment of FCD. However, long-term fistula healing can be achieved in only 30-50% of patients. In recent years, emerging data in the advent of therapeutic modalities, including the use of new biologic agents, therapeutic drug monitoring, novel surgical methods and mesenchymal stem cell therapy, have been shown to improve outcomes in achieving fistula healing. This review summarizes the existing literature on current and emerging therapies to provide guidance beyond RCTs in managing FCD.
瘘管形成型克罗恩病（FCD）仍然是治疗克罗恩病（CD）患者最具挑战性的方面。FCD可见于高达30%的CD患者，可能导致严重残疾和生活质量受损。FCD的最佳治疗策略需要多学科方法，包括药物和手术联合治疗。由于随机临床试验（RCT）的证据不足，FCD的治疗选择有限。目前的建议主要基于RCT的事后分析、真实世界临床研究和专家意见。胃肠病学家和外科医生在日常临床实践中存在差异。抗肿瘤坏死因子治疗在FCD治疗中的证据最为充分。然而，只有30%至50%的患者能够实现长期瘘管愈合。近年来，包括使用新型生物制剂、治疗药物监测、新型手术方法和间充质干细胞治疗在内的治疗模式出现了新的数据，这些数据已显示可改善瘘管愈合的结果。本综述总结了关于当前和新兴疗法的现有文献，以在RCT之外为管理FCD提供指导。
