recurrent fistula

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recurrent fistula

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sheeezooo
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08/31/06 - 11:24 AM

what is best treatment for recurrent perirectal fistulas in pts with crohns disease?

1.mesalamine

2.infliximab

3.ciprofloxacin

4.prednisone

5.surgery

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frank100
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08/31/06 - 11:30 AM

infliximab

sheeezooo
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08/31/06 - 11:36 AM

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cbenitesch
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08/31/06 - 12:54 PM

Sea_gull
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08/31/06 - 01:49 PM

Perianal fistula

First line therapy

Metronidazole or
Ciprofloxacin or
The combination of above

Infliximab is used only in refractory cases

GL

study_ing
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08/31/06 - 01:53 PM

vow guys thanx

smiling face

im surprised it isnt surgery !!

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sheeezooo
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08/31/06 - 02:08 PM

2.
fistulizing crohns disease is best treated with infusions of infliximab.this anti tumor necrosis factor is effective and safe in treating the disease.person must be evaluated for tuberculosis prior to treatment

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Sea_gull
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08/31/06 - 02:16 PM

sheeezooo wrote:
2.
fistulizing crohns disease is best treated with infusions of infliximab.this anti tumor necrosis factor is effective and safe in treating the disease.person must be evaluated for tuberculosis prior to treatment

Dear

Here is reference from "Conn's current therapy 2006"

"First-line therapies for perianal fistulas include metronidazole1 (10 to 20 mg/kg/day) or ciprofloxacin1 (1 g/day). Combining the two antibiotics may also be effective if monotherapy fails. Antibiotics can be tapered once these fistulas close, although some patients may require chronic antibiotic therapy. AZA1 or 6-MP1 can be used to treat fistulous CD that does not respond to antibiotics. Infliximab, infused at a dose of 5 mg/kg at 0, 2, and 6 weeks with subsequent maintenance therapy (usually at 5 mg/kg every 8 weeks thereafter) can be used as an alternative to AZA or 6-MP, or in conjunction with these medications. Because of the significant toxicity of cyclosporine, intravenous cyclosporine1 (4 mg/kg) should be reserved for patients whose disease remains unresponsive to the aforementioned therapies"

GL

tolito
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08/31/06 - 03:10 PM

never surgery in crohn's disease. will not heal. new fistulas will keep cropping up.

differential diagnosis in a young person with chronic recurrent perianal fistula,

crohn's
tb
chronic granulomatous diseases
hiv
actinomycosis
hidradenitis supprativa
schistosomiasis

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sheeezooo
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08/31/06 - 03:35 PM

#10

thanks sea_gull nice explaination
thx tolito

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Sea_gull
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08/31/06 - 03:52 PM

#11

tolito wrote:
never surgery in crohn's disease. will not heal. new fistulas will keep cropping up.

differential diagnosis in a young person with chronic recurrent perianal fistula,

crohn's
tb
chronic granulomatous diseases
hiv
actinomycosis
hidradenitis supprativa
schistosomiasis

In fact there are two types of fistulas in Crohn's

Internal : They are treated with surgery

External as are under discussion :Treated with drugs.

GL

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