Treatment Strategies in Crohn's-Associated Rectovaginal Fistula

Clinics in Colon and Rectal Surgery 2019; 32: 261-267 DOI: 10.1055/s-0039-1683908Rectovaginal fistula (RVF) is a rare, but dreaded complication of Crohn's disease (CD) that is exceedingly difficult to manage. Treatment algorithms range from observation and medical therapy to local surgical repair and proctectomy. The multitude of surgical options and lack of consensus between experts speak to the complexity and shortcomings encountered to correct this disease process surgically. The key to successful management of these fistulae therefore rests on a multidisciplinary approach between the patient, gastroenterologists, and surgeons, with open communication about expectations and goals of care. In this article, we review the management of CD-associated RVF with an emphasis on surgical technique. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Clinics in Colon and Rectal Surgery - Category: Surgery Authors: Tags: Review Article Source Type: research

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CONCLUSIONS: Laparoscopic surgery for isolated ileosigmoid fistulas in Crohn’s disease is safe and does not result in a different length of stay or incidence of postoperative complications. Primary repair (rather than resection) of the sigmoid colon in these cases, when feasible, appears to be safe and is likely to be cost-effective given the reduced length of stay. See Video Abstract at http://links.lww.com/DCR/A993. TÉCNICAS QUIRÚRGICAS Y DIFERENCIAS EN LOS RESULTADOS POSTOPERATORIOS PARA LOS PACIENTES CON ENFERMEDAD DE CROHN CON FÍSTULAS ILEO-SIGMOIDEAS: UNA EXPERIENCIA EN UNA SOLA INSTITUC...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Inflammatory Bowel Disease Source Type: research
This study proposes the positive correlation between the prevalence of STAT3 rs744166 risky allele "A" with the severity of disease in a cohort of 94 CD patients. In addition, the results suggest an increased STAT3 activity in the inflamed ileum of CD patients, compared to unaffected ileum sections. Notably, IL-23 triggers the differentiation of CD117+NKp44- ILC3s and induces the activation of STAT3 in both CD117+NKp44- and CD117-NKp44- ILC subsets, implying the involvement of STAT3 in the initiation of ILC plasticity. Moreover, carriage of STAT3 "A" risk allele exhibited a higher basal level of STAT3 t...
Source: Journal of Immunology Research - Category: Allergy & Immunology Tags: J Immunol Res Source Type: research
Abstract BACKGROUND: Different histological growth patterns (HGPs) of colorectal carcinoma (CRC) liver metastasis are associated with patients' prognosis and response to antiangiogenic therapy. However, the relationship between HGPs of liver metastasis and clinicopathological and genomic characteristics of primary cancer has not been well established. AIM: To assess whether certain clinicopathological and genomic features of primary CRC could predict the HGPs of liver metastasis. METHODS: A total of 29 patients with paired resections of both primary CRC and liver metastasis were divided into two groups: ...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
This study indicated that abnormal increased expressions of TGFβ1, TβR2, Smad3, and Snail were significantly downregulated by herbs-partitioned moxibustion at Tianshu (ST25) and Qihai (RN6) and acupuncture at Zusanli (ST36) and Shangjuxu (ST37). In addition, protein and mRNA levels of E-cadherin, the epithelial cell marker, were significantly increased. Protein and mRNA levels of fibronectin, the mesenchymal cell marker, were decreased in the intestinal tissue. Moreover, the number of mesenchymal cells in the intestinal mucosa can be reversely transformed to intestinal epithelial cells. Therefore, herbs-partition...
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research
Abstract Mesenchymal stem cells (MSCs) are isolated from multiple biological tissues-adult bone marrow and adipose tissues and neonatal tissues such as umbilical cord and placenta. In vitro, MSCs show biological features of extensive proliferation ability and multipotency. Moreover, MSCs have trophic, homing/migration and immunosuppression functions that have been demonstrated both in vitro and in vivo. A number of clinical trials are using MSCs for therapeutic interventions in severe degenerative and/or inflammatory diseases, including Crohn's disease and graft-versus-host disease, alone or in combination with ot...
Source: Cellular and Molecular Life Sciences : CMLS - Category: Cytology Authors: Tags: Cell Mol Life Sci Source Type: research
In conclusion, the results improve our understanding on the characteristics of lncRNAs and mRNAs on regulating host immune response against C. perfringens type C infection, which will provide a reference for future research into exploring C. perfringens-related diseases in human. Introduction Clostridium perfringens (C. perfringens) is a Gram-positive anaerobic rod and ranks as the second most common bacteria that causes fulminant, fatal infectious and immune diseases (Scharff, 2012; Grass et al., 2013). These diseases are characterized by fever, pain, gas production, local edema, and severe tissue destruction, the...
Source: Frontiers in cellular and infection microbiology - Category: Microbiology Source Type: research
Laura Stronati1, Francesca Palone2, Anna Negroni3, Eleonora Colantoni2, Anna Barbara Mancuso2, Salvatore Cucchiara2, Vincenzo Cesi3, Sara Isoldi2 and Roberta Vitali3* 1Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy 2Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University of Rome, Rome, Italy 3Division of Health Protection Technologies, Territorial and Production Systems Sustainability Department, ENEA, Rome, Italy Gut mucosal healing (MH) is considered a key therapeutic target and prognostic parameter in the management of inflammatory bowel disease (I...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
This study was carried out in accordance with the recommendations of the ethics standards defined by the EU legislation on the use of experimental animals (2010/63/EU) and Czech animal welfare act. The protocol was approved by the Institute of Microbiology animal care and use committee (approval ID: 85/2015 and 108/2016). Diets and Experimental Design In most experiments, shortly after weaning, the mice were switched either to animal protein-based diet—control (aCD, 176 g/kg crude protein; Cat# C1000) and high-protein diet (aHPD, 514 g/kg crude protein; Cat# C1001) or plant protein-based diet—control (pCD, 17...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
This study showed a good safety and tolerability profile of the studied substance (Monteleone et al., 2012). Since TGFβ has been described to induce the profibrogenetic response of fibroblasts, patients were monitored for 6 months with intestinal ultrasonography, not showing signs of intestinal stenosis. Moreover, half of the patients maintained remission during the 6 months follow up period (Zorzi et al., 2012). Afterwards, a randomized, double-blind, phase 2 study was conducted in CD patients with inflammatory lesions in the terminal ileum and/or right colon, with steroid-dependence/resistance, randomized to three ...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Noymar Luque-Campos1, Rafael A. Contreras-López1, María Jose Paredes-Martínez1, Maria Jose Torres2, Sarah Bahraoui3, Mingxing Wei4, Francisco Espinoza5, Farida Djouad3*, Roberto Javier Elizondo-Vega6* and Patricia Luz-Crawford1* 1Laboratorio de Inmunología Celular y Molecular, Centro de Investigación Biomédica, Facultad de Medicina, Universidad de los Andes, Santiago, Chile 2Escuela de Ingeniería Bioquímica, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile 3IRMB, INSERM, Univ Montpellier, Montpellier, France 4Cellvax, SAS...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
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