New Paradigm Guides Crohn's Treatment Selection for Better Patient Outcomes

Researchers from Penn State College of Medicine have published what they describe as the first medical and surgical approach care plan for the management of a serious complication of Crohn’s disease. Septic perianal Crohn’s disease impacts about 40% of patients with the condition, and is characterized by infected abscesses that develop into fistulas. These wounds are hard to treat and cause chronic pain and discomfort. Considerable hope for managing the complication was ignited with the 1998 introduction of the immunosuppressant infliximab, but only 25% of patients receiving the medication continued to improve after one year. Walter Koltun, MD, professor of surgery at the Inflammatory Bowel Disease Center, Penn State Hersey, summarized, “What was thought to be a silver bullet of sorts for this problem really is not.”

Along with colleagues at the Milton S. Hersey Medical Center, the Penn State researchers have been working for over 10 years to develop and test a better treatment plan, coordinating medications and surgery. The new protocol is a decision tree describing when and how surgical intervention could be engaged in cases that are not responsive to medications. Of 135 cases of septic perianal Crohn’s disease treated with the protocol, the team reported 60% achieved complete healing lasting at least 6 months, and an additional 20% saw partial improvement. Dr Kolton commented, “What we did with this study is look at a combined medical and surgical protocol for managing this problem, recognizing that there’s a role for the medicines, and there’s a role for the surgery. Although this is acknowledged by most surgeons and gastroenterologists, no one had written down a protocol to follow that is predictable in its outcome.” The findings are published in Journal of the American College of Surgeons.

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