Stem cell therapy for perianal Crohn's

Purpose of review Perianal Crohn's disease is a morbid and disabling condition, notoriously difficult to successfully treat with conventional medical and surgical therapies. Mesenchymal stem cells (MSCs) are an emerging novel therapy for perianal Crohn's disease. Recent findings Over 300 patients with perianal Crohn's disease have now been treated with MSCs in the context of clinical trials. All trials have demonstrated safety, and efficacy superior to conventional therapy with biologics and surgical intervention. This was consistent despite the heterogeneity in study protocols including variability in cell dosing, mode of delivery, repeat dosing, and allogeneic versus autologous donors. Sustained healing to 1 year has also been demonstrated in a recent extension of the largest phase III study confirming superior efficacy of MSCs to placebo at 1-year follow-up. However, several outstanding questions regarding the use of MSCs for perianal Crohn's disease remain, which, if answered, could enhance MSCs’ treatment efficacy. These include defining the optimal MSC donor, optimal MSC source (e.g., bone marrow versus adipose tissue), investigating a potential alloimmune response following allogeneic cellular delivery, and determining the optimal mode for MSC delivery. In addition to these unanswered questions, significant challenges in the required infrastructure and cost required for cell-based therapies may drive future research toward identifying novel acellular therapi...
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: INFLAMMATORY BOWEL DISEASE: Edited by Miguel Regueiro Source Type: research

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Authors: Egal A, London J, Lidove O, Atienza P, Etienney I Abstract Numerous systemic diseases (vasculitis, connective tissue disease or sarcoidosis) can display an involvement of the perianal skin, the rectum and/or the anus. Such knowledge is important in order to treat these complications specifically when possible. Lesions of the anorectum arising from systemic diseases can sometimes cause perforations in the peritoneal cavity (if concerning the higher portion of the rectum) and/or fistulization to the anal margin. Differential diagnosis, mostly infectious or inflammatory (Crohn's disease) must be ruled out in ...
Source: Revue de Medecine Interne - Category: Internal Medicine Tags: Rev Med Interne Source Type: research
CONCLUSIONS: BTA injection associated with fissurectomy is a safe and effective procedure in patients with CAF, avoiding the need of LIS in a high percentage of patients. PMID: 31333035 [PubMed - as supplied by publisher]
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Tags: Rev Esp Enferm Dig Source Type: research
Clinics in Colon and Rectal Surgery 2019; 32: 255-260 DOI: 10.1055/s-0039-1683907Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues them...
Source: Clinics in Colon and Rectal Surgery - Category: Surgery Authors: Tags: Review Article Source Type: research
Perianal diseases, common complications of Crohn's disease, are difficult to diagnose/manage. Patients with perianal Crohn's disease suffer from persistent pain and drainage, recurrent perianal sepsis, impaired quality of life, and financial burden. Conventional medical and surgical therapies carry risk of infection, myelosuppression, incontinence, disease recurrence. Although the phenotype of Crohn's disease has been extensively studied, reported outcomes are inconsistent. Endoanal ultrasonography is also becoming popular because of low cost and ability to acquire images in real time. Emerging management strategies for tr...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Source Type: research
CONCLUSION: Ulcerative colitis presented a high frequency of intestinal symptoms, and Crohn ’ s disease showed a high frequency of systemic manifestations at the onset of manifestation. There was a long delay in diagnosis, but individuals with more extensive disease and more obvious symptoms showed a shorter delay.RESUMO CONTEXTO: O diagn óstico da doença inflamatória intestinal é frequentemente retardado pela falta de capacidade para reconhecer as suas principais manifestações clínicas. OBJETIVO: Nosso estudo teve como objetivo descrever as manifestações...
Source: Arquivos de Gastroenterologia - Category: Gastroenterology Source Type: research
CONCLUSION: Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to anti-tumour necrosis factor-α agents, as evidenced by high failure and relapse rates. PMID: 30479468 [PubMed - in process]
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
ConclusionsThe treatment of anal fistulae with the OTSC® device is a safe sphincter-saving technique in the short term.ResumenIntroducciónEl tratamiento de la fístula anal con el dispositivo OTSC®(over-the-scope-clip) consiste en la inserción de un clip de una aleación elástica denominado Nitinol que ejerce una presión constante sobre el orificio fistuloso interno y facilita el cierre de la fístula. El objetivo de este estudio es analizar los resultados a corto plazo de esta técnica en una serie de casos.MétodosAnálisis retrospectivo de una serie...
Source: Cirugia Espanola - Category: Surgery Source Type: research
Aim: 14-26% of those suffering from Crohn's disease develop anal fistulas with perianal variants comprising half of all cases. This literature review aims to evaluate medical and surgical treatment options for these patients by comparing primary outcomes such as postoperative fistula healing rates (weeks), episodes of incontinence and sepsis.
Source: International Journal of Surgery - Category: Surgery Authors: Source Type: research
Conclusions The treatment of anal fistulae with the OTSC® device is a safe sphincter-saving technique in the short term.
Source: Cirugia Espanola - Category: Surgery Source Type: research
Summary BackgroundPatient reported outcomes regarding perianal disease and faecal incontinence in the community‐based inflammatory bowel disease population are poorly described. AimsTo determine the impacts of perianal disease and faecal incontinence on quality of life and employment in inflammatory bowel disease patients. MethodsFor this cross‐sectional study, a comprehensive survey was sent out to members of the Dutch National Crohn's and Colitis patient organisation. Validated questionnaires regarding faecal incontinence and active perianal disease were used to estimate its prevalence's. The effect on the quality of...
Source: Alimentary Pharmacology and Therapeutics - Category: Drugs & Pharmacology Authors: Tags: ORIGINAL ARTICLE Source Type: research
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