Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2475-2482
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2475
Long-term outcome of infliximab combined with surgery for perianal fistulizing Crohn's disease
Bo-Lin Yang, Yu-Gen Chen, Yun-Fei Gu, Hong-Jin Chen, Gui-Dong Sun, Ping Zhu, Wan-Jin Shao
Bo-Lin Yang, Yu-Gen Chen, Yun-Fei Gu, Hong-Jin Chen, Gui-Dong Sun, Ping Zhu, Wan-Jin Shao, Department of Colorectal Surgery, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Author contributions: Yang BL and Chen YG contributed equally to this work; Yang BL and Gu YF designed the research; Yang BL, Chen HJ, Sun GD and Zhu P performed the research; Yang BL and Shao WJ analyzed the data; Yang BL and Chen YG wrote the paper.
Supported by Grants from Priority Academic Program Development of Jiangsu Higher Education Institutions, Jiangsu Provincial Clinical Medicine of Science and Technology Project, No. BL2014100.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bo-Lin Yang, MD, Department of Colorectal Surgery, the Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. blyang1971@163.com
Telephone: +86-25-86618942 Fax: +86-25-86618942
Received: August 10, 2014
Peer-review started: August 11, 2014
First decision: August 27, 2014
Revised: September 15, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 28, 2015
Processing time: 202 Days and 6.1 Hours
Abstract

AIM: To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease (CD).

METHODS: The work was performed as a prospective study. All patients received infliximab combined with surgery to treat perianal fistulizing CD, which was followed by an immunosuppressive agent as maintenance therapy.

RESULTS: A total of 28 patients with perianal fistulizing CD were included. At week 30, 89.3% (25/28) of the patients were clinically cured with an average healing time of 31.4 d. The CD activity index decreased to 70.07 ± 77.54 from 205.47 ± 111.13 (P < 0.01) after infliximab treatment. The perianal CD activity index was decreased to 0.93 ± 2.08 from 8.54 ± 4.89 (P < 0.01). C-reactive protein, erythrocyte sedimentation rate, platelets, and neutrophils all decreased significantly compared with the pretreatment levels (P < 0.01). Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up. After a median follow-up of 26.4 mo (range: 14-41 mo), 96.4% (27/28) of the patients had a clinical cure.

CONCLUSION: Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD, and this treatment was associated with better long-term outcomes.

Keywords: Infliximab; Surgery; Crohn’s disease; Anal fistula

Core tip: Infliximab (IFX) combined with surgery for the treatment of Crohn’s disease (CD) anal fistula has significant effects, improves the clinical cure rate, and shortens the fistula healing time. Our findings indicate that IFX combined with surgical treatment is the reasonable treatment for anal fistulas in CD and that the normal ranges of CD activity index and C-reactive protein do not mean the endoscopic healing.