Predicting relapses of perianal fistulas

Did you know that perianal Crohn’s disease is both commonly diagnosed and a marker of more severe disease? Research estimates the incidence of perianal Crohn’s ranges from 17-43% of Crohn’s cases. For many of these patients, perianal disease comes with a host of complications, including fistulas – abnormal connections that form between the intestines and another organ or the skin. 

About 35-50% of adults with Crohn’s disease will develop a fistula at some point in their disease journey. Fistulas are difficult to treat, and usually done so with a combination of medications and surgery. But despite using these medical interventions, fistula relapse does still occur in 20-30% of patients within the first year after treatment.

A recent study published in Inflammatory Bowel Disease looked at identifying predictors of fistula relapse in Crohn’s patients. We know of a few predictors previously identified that are associated with relapse – young age, disease location, and history of abdominal surgery. But the authors of “Predictors of Perianal Fistula Relapse in Crohn’s Disease” sought to find additional predictors for patients after undergoing medical and surgical treatment. 

The study included 137 patients from Maison de Santé Protestante de Bordeaux-Bagatelle, Talence, France who had operations for fistulizing perianal Crohn’s disease from January 2007-December 2015. Of the patients included, 76% were started on an anti-TNF biologic (adalimumab or infliximab) and 39% were started on combination therapy (immunosuppressant and an anti-TNF). The patients were followed for 26-64 months and during that time, the anti-TNF was stopped in 14% of patients and combination therapy was stopped in 58% of patients.

What did the study find out?

The results of the study found that:

  • Patients who discontinued an anti-TNF medication had a 3.5-fold increase in risk of fistula relapse 
  • Discontinuation of the immunosuppressant was associated with a decreased risk of relapse

This means that if you have perianal disease and have had surgery to treat a fistula, continuing anti-TNF treatment may decrease your risk of relapse. 

How this helps patients now

The results from this study provides important information that patients dealing with fistulas can discuss with their doctor. If you have had a surgical procedure to treat a fistula or are considering one, make sure you discuss your treatment options – both medical and surgical - with your doctor so you understand fully what to expect during recovery and afterwards. It is important to follow your treatment plan as prescribed, even if you start to feel better. 

Foundation research on fistulizing disease

In addition to this research, the Foundation is funding a study of a new medical device product that could provide a minimally invasive approach to treating fistulas. With an investment made through our IBD Ventures program, Tissium is looking at applying their polymer research into IBD. Tissium has a biocompatible and biodegradable light-activated gel that works almost like a glue – it can be applied to a wound and it integrates with the surrounding tissue to help heal it without harming any living tissue.

The product was originally used in cardiac surgery and can be used as a sealant, adhesive, barrier, or vehicle for drug delivery. Now Tissium is looking at applying it for treatment of perianal fistulas, in which the polymer will seal the fistula hole and will also act as a scaffolding on which new healthy cells can grow. Thus, Tissium is currently working to provide preclinical proof of concept that its polymer technology is useful for perianal fistulas.

Rebecca Kaplan is the Public Affairs and Social Media Manager for the Crohn's & Colitis Foundation and the caregiver of a Crohn's disease patient.