Perianal Disease and Fistulas in Inflammatory Bowel Disease скачать в хорошем качестве

Perianal Disease and Fistulas in Inflammatory Bowel Disease

Learn about the types of perianal disease, causes, prevention, and management of perianal disease including fistulas and abscesses. Treatment options include biologic therapies, antibiotics, immunomodulators, surgery, stem cell therapies, and hyperbaric oxygen therapy. The impact of perianal disease on symptoms such as pain, productivity (work, school), sexual health, and mental health are also discussed. Speaker: Dr. Jeffrey McCurdy (MD, PhD, FRCPC) is a Gastroenterologist and Assistant Professor of Medicine at the University of Ottawa. He received his PhD in Immunology from Dalhousie University in 2004, and his MD from the University of Ottawa in 2007. He completed his Internal Medicine (2010) and Gastroenterology (2012) training at Dalhousie University. Following this he completed an advanced fellowship in Inflammatory Bowel Disease at Mayo Clinic, Rochester in 2013. He joined the Department of Medicine, Division of Gastroenterology at the University of Ottawa in 2013. Dr. McCurdy's research interests include understanding and identifying predictors of disease related outcomes in inflammatory bowel disease. For more information please visit www.crohnsandcolitis.ca/gls. 0:00 Introduction 3:52 Speaker introduction 5:37 Presentation start 6:43 Perianal Crohn’s disease 8:01 Why should we care about perianal fistulas? 9:17 Fistulas are common 10:47 Epidemiology Update 12:07 Symptoms of perianal fistulas 13:15 Impact of perianal fistulas 15:13 Recurrence of perianal fistulas 15:34 Direct cost of care 16:53 Treatment of fistulas 17:12 Treatment goals 19:52 Evaluation of fistulas tracts 21:20 Simple vs complex fistula 21:58 Treatment approach 23:32 Traditional medical options 24:17 1st randomized clinical trial 25:43 Anti-TNF therapy 27:20 Potential strategies to improve fistula healing 32:52 Combined surgical & anti-TNF therapy 34:16 Antibiotics & anti-TNF therapy 36:06 Higher IFX trough predicts healing 37:53 Surgery for perianal disease 38:08 Surgical options 40:26 Impact of fecal diversion 42:47 Bowel restoration after diversion 42:58 Success of bowel restoration 43:32 Emerging treatment options 43:42 New biologics 44:50 Mesenchymal stem cells 46:50 ADMIRE I trial 47:36 ADMIRE I: Results 48:37 Durability of treatment response 49:50 Hyperbaric oxygen therapy 52:14 Effectiveness of HBOT 53:37 Conclusions 54:20 Question & Answer period 54:57 Are hemorrhoids a condition directly related to Crohn’s or can there be other causes? What are the treatment options? 58:12 I have issues with leakage after I have a bowel movement. Is that normal? 59:13 Once you have had anal fissures, are you more prone to them in future? 1:00:19 Is there any way to prevent abscesses from forming within perianal fistula tracts or how to get rid of them? 1:02:31 Are there warning signs or predictors of a developing fistula? 1:03:22 What comes first for problematic fistula site – increasing your biologic dose OR putting in a seton? 1:05:35 What are the treatment options for fistulae that appear all around the perineum and groin area? 1:08:08 Are there any “natural” remedies/treatments that can help treat perianal disease? And are there any studies investigating this? 1:09:52 Is there a way to stop perianal skin tags from reoccurring? 1:11:07 Are there treatment options for fecal incontinence? 1:12:48 Closing remarks