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Review
. 2019 Dec 30;4(3):340-344.
doi: 10.1002/jgh3.12295. eCollection 2020 Jun.

Radiological outcomes in perianal fistulizing Crohn's disease: A systematic review and meta-analysis

Tanya Lee  1 , Eric Yong  2 , Nik S Ding  3
Affiliations
Review

Radiological outcomes in perianal fistulizing Crohn's disease: A systematic review and meta-analysis

Tanya Lee et al. JGH Open. .

Abstract

Perianal fistulas are a common and debilitating manifestation of Crohn's disease. Since the advent of biological agents, patient outcomes appear to have improved. While rates of clinical response and remission are well characterized in literature, magnetic resonance imaging (MRI) outcomes remain less so. This is despite previous studies demonstrating the persistence of fistula tracts on MRI, in spite of clinical healing, suggesting radiological markers of improvement may be more accurate. The aims of this study were to systematically review the literature for all studies reporting on MRI outcomes following biological therapy and to compare rates of radiological healing to clinical remission. A search was performed according to the Preferred Reporting Items For Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Nine articles were included, with a total sample size of 259 patients. Of these 259 patients, 47% achieved clinical remission following induction therapy and 42% following a median of 52 weeks' maintenance therapy. Out of the 259 patients, 7% achieved radiological healing in the short term and 25% in the long term. The odds ratio of MRI versus clinical healing was 0.10 (95% confidence interval [CI], 0.02-0.39) and 0.43 (95% CI, 0.26-0.71), respectively, at those corresponding time points. MRI healing of perianal fistulizing Crohn's, while arguably a more accurate assessment of treatment response, is significantly less common than clinical remission. Heterogeneity exists in the definition of radiological and clinical response, leading to variation in reported rates. Further studies, directly comparing the long-term outcomes of patients achieving clinical remission and MRI healing are required, to better inform the role of MRI follow up in clinical practice.

Keywords: Crohn's disease; biological therapy; magnetic resonance imaging; rectal fistula; tumor necrosis factor‐alpha.

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Figures

Figure 1
Figure 1
A PRISMA diagram outlining the search and study selection methods.9
See this image and copyright information in PMC

References

    1. Ng SC, Plamondon S, Gupta A, Burling D, Kamm MA. Prospective assessment of the effect on quality of life of anti‐tumour necrosis factor therapy for perineal Crohn's fistulas. Aliment. Pharmacol. Ther. 2009; 30: 757–66. - PubMed
    1. Yassin NA, Askari A, Warusavitarne J et al Systematic review: the combined surgical and medical treatment of fistulising perianal Crohn's disease. Aliment. Pharmacol. Ther. 2014; 40: 741–9. - PubMed
    1. Hellers G, Bergstrand O, Ewerth S, Holmström B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut. 1980; 21: 525–7. - PMC - PubMed
    1. Lichenstein G, Yan S, Bala M, Blank M, Sands BE. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn's disease. Gastroenterology. 2005; 128: 862–9. - PubMed
    1. 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: 1398–405. - PubMed

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