{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T18:46:40Z","timestamp":1776710800915,"version":"3.51.2"},"reference-count":38,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,9,18]],"date-time":"2018-09-18T00:00:00Z","timestamp":1537228800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Treatment paradigms for Crohn\u2032s disease with perianal fistulae (CD\u2010pAF) are evolving.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To study the impact of multimodality treatment in CD\u2010pAF on recurrence rates and the need for re\u2010interventions and to identify predictive factors for these outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a multinational multicentre retrospective cohort study. Multimodality approach was defined as using a combination of medical treatments (anti\u2010TNFs \u00b1 immunomodulators \u00b1 antibiotics) along with surgical approach (examination under anaesthesia (EUA) \u00b1 seton drainage) at diagnosis of CD\u2010pAF. Univariable and multivariable analyses were performed for variables indicative of the need for reintervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 253 patients were included. 65% of patients received multimodality approach. Multimodality treatment resulted in complete fistula healing in 52% of patients. Re\u2010intervention was needed in 27% of patients with simple and in 40.3% of those with complex fistula. On multivariable analysis multimodality treatment (OR: 0.35, 95% CI: 0.17\u20100.57, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001), seton removal (OR: 0.090, 95% CI: 0.027\u20100.30, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0001, therapy with infliximab (OR: 0.19, 95% CI: 0.06\u20100.64, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007), and therapy with adalimumab (OR: 0.12, \"95% CI: 0.026\u20100.56, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.007) were predictive of avoiding repeat surgery. Proctitis (OR: 3.76, 95% CI: 1.09\u201012.96, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03) was predictive of the need for radical surgery (proctectomy, diverting stoma) while multimodality treatment reduced the need for radical surgery (OR: 0.21, 95% CI: 0.05\u20100.81, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Multimodality treatment, anti\u2010TNFs use, and removal of setons after multimodality treatment can result in improved outcomes in CD patients with perianal fistulae and reduce the need for repeat surgery and radical surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.14969","type":"journal-article","created":{"date-parts":[[2018,9,18]],"date-time":"2018-09-18T10:37:55Z","timestamp":1537267075000},"page":"941-950","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["The role of multimodal treatment in Crohn\u2032s disease patients with perianal fistula: a multicentre retrospective cohort study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3670-6545","authenticated-orcid":false,"given":"Shaji","family":"Sebastian","sequence":"first","affiliation":[{"name":"Hull UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Black","sequence":"additional","affiliation":[{"name":"Hull UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Armuzzi","sequence":"additional","affiliation":[{"name":"Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-5752","authenticated-orcid":false,"given":"Kapil","family":"Sahnan","sequence":"additional","affiliation":[{"name":"London 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