Dr Holubar reviews medical and surgical options for treating perianal Crohn's disease.

Stefan Holubar, MD, is chief of the Inflammatory Bowel Disease Section and director of research for the Department of Colon & Rectal Surgery at Cleveland Clinic in Cleveland, Ohio.

Hi, I'm Stefan Holubar from the IBD surgery section at Cleveland Clinic where I'm also the director of research, and I just presented on perianal Crohn's disease at AIBD regionals in Boston. We started by talking about the epidemiology of perianal Crohn's disease which is unfortunately very common. It affects about 25% of Crohn's patients. Overall, about 5% have isolated perianal Crohn's disease, which can be very difficult to diagnose.

We then talk about the goals of surgery in Crohn's disease, which is a bit different than the goals of surgery for ulcerative colitis. And then we move on to talk about the depth and breadth of the variety of surgical procedures that we use to try to close fistulas. We do know from some recent studies that the goal for getting rid of fistulas should be to go for radiographic closure because clinical closure is associated with a higher recurrence rate.

And we actually do want to go for surgical closure because that study suggested that medical therapy alone is not going to be as effective for closure as compared with surgical therapy. Then, we talk about the armamentarium of medicines which can help perianal Crohn’s disease to achieve surgical closure, and then finally finish out with what's new in the field, including talking about the recent ADMIRE II study update, which unfortunately did not show any difference or efficacy of stem cells, allogenic stem cells for efficacy in closing perianal fistulas in Crohn's patients. But the problem with that is that they had, as a comparator, sutured closure and curettage of the tract for both arms, so that may be a reason why it was a negative study.

But we also talk about some other new kids on the block, including autologous stem cell preparations, namely platelet-rich plasma and adipose-derived stromal fractions.

And then finally we talk about the TOpclass consortium, which is a new international effort that is aimed at learning more about the epidemiology and treatment of perianal Crohn's disease: the TO in TOpclass stands for treatment optimization.

Thank you very much.