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Perianal fistulizing Crohn's disease: pathogenesis, diagnosis and therapy
Nature Reviews Gastroenterology & Hepatology ( IF 65.1 ) Pub Date : 2017-08-09 , DOI: 10.1038/nrgastro.2017.104
Julián Panés , Jordi Rimola

Perianal fistulizing Crohn's disease has a major negative effect on patient quality of life and is a predictor of poor long-term outcomes. Factors involved in the pathogenesis of perianal fistulizing Crohn's disease include an increased production of transforming growth factor β, TNF and IL-13 in the inflammatory infiltrate that induce epithelial-to-mesenchymal transition and upregulation of matrix metalloproteinases, leading to tissue remodelling and fistula formation. Care of patients with perianal Crohn's disease requires a multidisciplinary approach. A complete assessment of fistula characteristics is the basis for optimal management and must include the clinical evaluation of fistula openings, endoscopic assessment of the presence of proctitis, and MRI to determine the anatomy of fistula tracts and presence of abscesses. Local injection of mesenchymal stem cells can induce remission in patients not responding to medical therapies, or to avoid the exposure to systemic immunosuppression in patients naive to biologics in the absence of active luminal disease. Surgery is still required in a high proportion of patients and should not be delayed when criteria for drug failure is met. In this Review, we provide an up-to-date overview on the pathogenesis and diagnosis of fistulizing Crohn's disease, as well as therapeutic strategies.



中文翻译:

肛周瘘管克罗恩病:发病机制,诊断和治疗

肛周瘘管克罗恩病对患者的生活质量具有重大的负面影响,并且是长期预后不良的预兆。肛周瘘管克罗恩病的发病机理涉及的因素包括炎性浸润中转化生长因子β,TNF和IL-13的产生增加,诱导上皮向间质转化和基质金属蛋白酶上调,导致组织重塑和瘘管形成。肛周克罗恩病患者的护理需要多学科的方法。瘘管特征的完整评估是最佳治疗的基础,并且必须包括瘘管开口的临床评估,直肠镜是否存在的内窥镜评估以及MRI,以确定瘘管的解剖结构和脓肿的存在。间充质干细胞的局部注射可在对药物疗法无反应的患者中诱导缓解,或避免在没有活动性腔疾病的情况下未接触生物制剂的患者暴露于全身性免疫抑制。仍然有很大一部分患者需要手术,并且在达到药物衰竭的标准时不应拖延手术。在本综述中,我们提供了有关瘘管克罗恩病的发病机理和诊断以及治疗策略的最新概述。仍然有很大一部分患者需要手术,并且在达到药物衰竭的标准时不应拖延手术。在本综述中,我们提供了有关瘘管克罗恩病的发病机理和诊断以及治疗策略的最新概述。仍然有很大一部分患者需要手术,并且在达到药物衰竭的标准时不应拖延手术。在本综述中,我们提供了有关瘘管克罗恩病的发病机理和诊断以及治疗策略的最新概述。

更新日期:2017-08-31
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