Medical and Surgical Management of Pediatric Perianal Crohn's Disease: A Systematic Review
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In brief
In brief
This systematic review of 538 pediatric patients demonstrates that combination medical-surgical therapy achieves superior outcomes in perianal Crohn's disease compared to monotherapy. Infliximab combined with surgical intervention showed lowest recurrence rates (4.3%) versus seton placement alone (35.7%) or infliximab monotherapy (23.4%).
Written by the GCMD Library team from the article.
Background
The timely management of pediatric Crohn's disease (CD), and specifically perianal CD, is important owing to the possible adverse effects on growth, development, and quality of life. Perianal involvement is increasingly common, with up to 62% of pediatric CD patients affected. Presently, literature addressing the management of perianal CD has focused primarily on adults, with findings that cannot always be extrapolated to the pediatric population. We aimed to review the rates of healing, recurrence, and need for surgical intervention in perianal CD to provide evidence-based recommendations for the ideal management in children.
Method
We conducted a systematic review of CENTRAL, PubMed, Medline, and EMBASE databases (January 1997–December 2017) in accordance with PRISMA. Two independent reviewers performed data extraction.
Result
Ten studies met the inclusion criteria with a combined total of 538 patients. Median study population size was 17 (range 7–276), with a median age at intervention of 13.9 years (range 1–18). Seton placement allowed complete healing in 28.6% of children. Similar results (28.5%) were seen in children undergoing fecal diversion. One study demonstrated complete resolution of fistulizing disease in 70% of children treated with infliximab (IFX). One quarter of patients treated with IFX required further surgical intervention for disease control. Recurrence occurred most frequently in children undergoing Seton placement alone (5/14, 35.7%), compared with IFX (46/197, 23.4%) and combination therapy (12/276, 4.3%).
Conclusion
In the pediatric population, a combination of medical and surgical treatment is required to control perianal CD, with fewer side effects.
Level of evidence
Level II.