New Crohn Disease Care Plan Improves Outcomes

Researchers from Penn State College of Medicine and the Milton S. Hershey Medical Center have developed a combined medical and surgical plan designed to manage septic perianal Crohn disease SPCD), a serious complication that occurs in roughly 40% of patients with the disease.

Based on patient outcomes, the plan is the result of a decade-plus long study. The investigators sought to define the success of SPCD management with a combined medical and surgical approach, and to identify clinical and genetic factors predictive of healing.

The plan consists of a decision tree detailing when and what types of surgical treatment are appropriate for patients who do not respond to medical management, as well as what the chances of healing are in these patients.

The authors conducted a retrospective chart review of patients with SPCD treated at the Milton S. Hershey Medical Center, performing a genetic analysis of 185 single nucleotide polymorphisms linked to Crohn disease in 78 patients.

In total, 135 episodes of SPCD were identified in 114 patients. Overall, 80 of 135 episodes healed, and did not differ between those receiving tumor necrosis factor antagonists (anti-TNF) and those who did not, according to the authors, who note that there "appeared to be a consistent improved heal rate in each subcategory of surgically managed patients receiving anti-TNF. Twenty-two patients ultimately received a permanent diversion with either a total proctocolectomy or completion proctectomy.

A combined medical and surgical approach yielded a 60% rate of healing for SPCD, which the researchers note occurs in roughly 40% of patients with Crohn disease. Approximately 20% of SPCD patients will require a permanent stoma, according to the investigators, who add that there were no clear genetic predictors of healing SPCD.

Ultimately, "perineal Crohn disease should be managed by a specialty colorectal surgeon and IBD gastroenterologists," says study senior author Walter Koltun, MD, a professor of surgery at the Milton S. Hershey Medical Center. "That would be the teaching point for primary care practitioners."

—Mark McGraw

Reference:

Choi C, Berg A, Sangster W et al. Combined medical and surgical approach improves healing of septic perianal crohn's disease [published online June 5, 2016]. J Am Coll Surg. doi: 10.1016/j.jamcollsurg.2016.05.017..