Combined medical and surgical care plan helped patients with Crohn’s disease heal.
Researchers at Penn State College of Medicine spent more than 10 years developing and testing a care plan that helps doctors decide how and when to treat patients with septic perianal Crohn’s disease.
Crohn’s disease is one of several inflammatory bowel disorders. Patients have severe abdominal cramping, bleeding and diarrhea. About 40 percent of patients with Crohn’s disease develop infected abscesses that become fistulas–open wounds that are very difficult to treat.
At one time surgery was the preferred treatment, but a medication called infliximab, know by the brand name Remicade, helped suppress the inflammatory condition in about 60 percent of patients. After a year, however, only 25 percent of the patients still experienced healing.
“What was thought to be a silver bullet of sorts for this problem really is not,” lead author Walter A. Koltun, MD, said in a press release.
Dr. Koltun is a professor of surgery at Penn State College of Medicine.
Despite the expense and possibility of significant side effects, many patients with Crohn’s disease stay on infliximab through fear the condition will become worse if they stop the medication.
Dr. Koltun and colleagues have developed a care plan that helps doctors determine whether and when to continue the medication or to move to a surgical solution. The care plan is the first of its kind.
An analysis of 135 episodes of septic perianal Crohn’s disease found 60 percent of the patients treated with the new care plan healed and remained healed for at least six months. Half of the remaining patients improved but did not heal completely. The remainder did not heal and required surgery.
The researchers also analyzed genetic variations to see how they might affect healing, but results were not statistically significant.
“What we did with this study is look at a combined medical and surgical protocol for managing this problem, recognizing that there’s a role for the medicines, and there’s a role for the surgery,” Dr. Koltun said in the press release. “Our protocol provides a paradigm for when you perhaps should stop the drug and when to consider surgery with or without medication.”
The research and care plan were published in the June issue of the Journal of the American College of Surgeons.
Funding for the care plan was provided by the Carlino Fund for Inflammatory Bowel Disease Research.
None of the authors reported a conflict of interest.