Colorectal ConditionsMedical and surgical management of pediatric perianal crohn's disease: A systematic review☆
Section snippets
Background
Crohn's disease (CD) is defined as a chronic inflammatory bowel disease (IBD) affecting anywhere from the mouth to the anus. Both the etiology and pathogenesis of IBD remain poorly understood. Pediatric IBD, in particular CD, has increased in both incidence and prevalence worldwide over the last two decades, with Western countries having the highest reported rates of IBD. Perianal disease may affect 10%–62% of children, compared with 25%–80% of adults with CD [1,2]. Perianal CD in the pediatric
Study selection
Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, a systematic review of the literature was conducted. The project was also registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018085979), managed by the National Institute for Health Research.
The Cochrane Register of Controlled Trials (CENTRAL), PubMed, Medline and EMBASE databases were systematically reviewed to identify all studies that were published
Results
Ninety-one studies matched the search criteria. Ten studies met the inclusion criteria and were suitable for analysis (Fig. 1). Nine studies were retrospective and one was a subset of a randomized trial. There was a total of 538 patients. Of these, 289 patients had combined medical and surgical management: infliximab (IFX), 197; Seton, 14; 6-mercaptopurine (6-MP), 14; fistulectomy, 11; fecal diversion, 7; and 6 azathioprine (AZA), 6. The median size of the study population was 17 (range 7–276
Discussion
The management of perianal CD in the pediatric population is highly variable. Each treatment must be tailored to the individual, based upon disease severity and associated complications. The current literature on the management of pediatric perianal CD is limited and there is no standardized approach to treatment regimens. This systematic review extensively searched the literature in an attempt to provide recommendations for the management of this increasingly common condition.
The NASPGHAN
Acknowledgments
Associate Professor Sebastian King's position as an Academic Paediatric Surgeon is possible owing to a generous grant from The Royal Children's Hospital Foundation.
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Cited by (17)
When and Where Should Surgery Be Positioned in Pediatric Inflammatory Bowel Disease?
2023, Gastroenterology Clinics of North AmericaAnti TNF treatment of complex perianal fistulas in children without luminal Crohn's disease: Is it an option?
2022, Journal of Pediatric SurgeryCitation Excerpt :The specific etiology of perianal abscesses and fistulas, which may develop prior to or following symptoms of luminal Crohn's disease, is poorly understood [10]. However, guidelines for management of perianal fistulas in CD are well established, and optimally involve a combined approach of abscess drainage with Seton insertion plus anti TNF and antibiotics [3,10–13]. In contrast, reports regarding prevalence and treatment options for children with CPF in the absence of luminal CD are sparse.
Pediatric Inflammatory Bowel Disease for General Surgeons
2022, Surgical Clinics of North AmericaCitation Excerpt :Setons are inert foreign material (vessel loop, rubber drain, silk suture) that are attached to themselves and remain in place until the area has healed. This allows maximal medical therapy to occur uninterrupted due to recurrent infection without injury to the sphincter complex.13 Systematic review of pediatric patients with perianal disease demonstrate recurrence rates between 1 and 2 years of 35.7%, 23.4%, and 4.3% for Seton placement alone, infliximab therapy alone, and combination therapy, respectively.13
Amino acid-based enteral nutrition is effective for pediatric Crohn’s disease: a multicenter prospective study
2024, Gastroenterology Report
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Disclosures
Funding: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Conflict of interest: None.