RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0041-1730015
Profile of Crohn’s Disease Patients Who Underwent Anorectal Examination under Anesthesia
Abstract
Introduction Crohn’s disease (CD) is an inflammatory bowel disease, and in ∼ 30% of cases it is associated with perianal manifestations. To identify the extent of the damage and to implement an appropriate treatment, anorectal examination under anesthesia (EUA) is fundamental.
Objective To describe the profile of patients who underwent anorectal EUA in university and private hospitals in the state of Bahia, Brazil.
Methodology A retrospective, descriptive study with 46 patients who underwent anorectal EUA between March, 2016 and November, 2019.
Results A total of 62 anorectal EUAs were performed in 46 patients. With an average age of 36.8 years, the female gender was predominant (52.2%) among these patients. Anal fistulas were the most frequent findings (83.8%), and in most cases they were treated with a seton placement (69.4%). The main recommended surgical indication was a proper evaluation and identification of perianal disease, followed by drainage of the abscess and therefore immunobiological therapy (59.6%).
Conclusion In the present study, the profile of CD patients was similar to those found in the literature, with a high rate of complex anal fistulas. Additional studies are still necessary to further comprehend and treat this particular and debilitating manifestation of the disease.
Publikationsverlauf
Eingereicht: 21. August 2020
Angenommen: 15. Januar 2021
Artikel online veröffentlicht:
19. Juli 2021
© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Jacobsen BA, Fallingborg J, Rasmussen HH. et al. Increase in incidence and prevalence of inflammatory bowel disease in northern Denmark: a population-based study, 1978-2002. Eur J Gastroenterol Hepatol 2006; 18 (06) 601-606
- 2 Ng SC, Shi HY, Hamidi N. et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 2017; 390 (10114): 2769-2778
- 3 Penner A, Crohn BB. Perianal fistulae as a complication of regional ileitis. Ann Surg 1938; 108 (05) 867-873
- 4 Lewis RT, Bleier JI. Surgical treatment of anorectal Crohn’s disease. Clin Colon Rectal Surg 2013; 26 (02) 90-99
- 5 Regueiro M, Mardini H. Treatment of perianal fistulizing Crohn's disease with infliximab alone or as an adjunct to exam under anesthesia with seton placement. Inflamm Bowel Dis 2003; 9 (02) 98-103
- 6 Schwartz DA, Wiersema MJ, Dudiak KM. et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas. Gastroenterology 2001; 121 (05) 1064-1072
- 7 Hyder SA, Travis SP, Jewell DP, McC Mortensen NJ, George BD. Fistulating anal Crohn's disease: results of combined surgical and infliximab treatment. Dis Colon Rectum 2006; 49 (12) 1837-1841
- 8 Cellini C, Safar B, Fleshman J. Surgical management of pyogenic complications of Crohn's disease. Inflamm Bowel Dis 2010; 16 (03) 512-517
- 9 Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB. American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn's disease. Gastroenterology 2003; 125 (05) 1508-1530
- 10 Feuerstein JD, Cheifetz AS. Crohn’s Disease: Epidemiology, Diagnosis, and Management. Mayo Clin Proc 2017; 92 (07) 1088-1103
- 11 Cheifetz AS. Management of active Crohn disease. JAMA 2013; 309 (20) 2150-2158
- 12 Hellers G, Bergstrand O, Ewerth S, Holmström B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut 1980; 21 (06) 525-527
- 13 Mahid SS, Minor KS, Soto RE, Hornung CA, Galandiuk S. Smoking and inflammatory bowel disease: a meta-analysis. Mayo Clin Proc 2006; 81 (11) 1462-1471
- 14 Lakatos PL, Czegledi Z, Szamosi T. et al. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease. World J Gastroenterol 2009; 15 (28) 3504-3510
- 15 Brasil, Ministério da Saúde. Secretaria de Vigilância em Saúde. Vigitel Brasil, 2018: Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico Brasília: Ministério da Saúde; 2019
- 16 Schwartz DA, Loftus Jr EV, Tremaine WJ. et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122 (04) 875-880
- 17 Kotze PG, Shen B, Lightner A. et al. Modern management of perianal fistulas in Crohn's disease: future directions. Gut 2018; 67 (06) 1181-1194
- 18 Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RCG, Kamm MA. The clinical course of fistulating Crohn's disease. Aliment Pharmacol Ther 2003; 17 (09) 1145-1151
- 19 Eglinton TW, Barclay ML, Gearry RB, Frizelle FA. The spectrum of perianal Crohn's disease in a population-based cohort. Dis Colon Rectum 2012; 55 (07) 773-777
- 20 Keighley MRB, Allan RN. Current status and influence of operation on perianal Crohn's disease. Int J Colorectal Dis 1986; 1 (02) 104-107
- 21 Schwartz DA, Ghazi LJ, Regueiro M. et al; Crohn's & Colitis Foundation of America, Inc. Guidelines for the multidisciplinary management of Crohn's perianal fistulas: summary statement. Inflamm Bowel Dis 2015; 21 (04) 723-730
- 22 Present DH, Rutgeerts P, Targan S. et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999; 340 (18) 1398-1405
- 23 Gecse KB, Bemelman W, Kamm MA. et al; World Gastroenterology Organization, International Organisation for Inflammatory Bowel Diseases IOIBD, European Society of Coloproctology and Robarts Clinical Trials, World Gastroenterology Organization International Organisation for Inflammatory Bowel Diseases IOIBD European Society of Coloproctology and Robarts Clinical Trials. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease. Gut 2014; 63 (09) 1381-1392
- 24 Kotze PG, Albuquerque IC, da Luz Moreira A, Tonini WB, Olandoski M, Coy CSR. Perianal complete remission with combined therapy (seton placement and anti-TNF agents) in Crohn's disease: a Brazilian multicenter observational study. Arq Gastroenterol 2014; 51 (04) 284-289