A BDRF-funded review of medical practice has revealed major uncertainty in the way surgeons deal with anal fistulae in Crohn’s patients. The findings have been published in the British Journal of Surgery, calling for more research to address a ‘clear need for standardisation’ to deliver better treatment.

Around 1-in-3 people with Crohn’s will develop an anal fistula, which require complex specialist treatment. Anal fistula is an extremely debilitating problem which can blight and destroy lives for years at a time. Excruciating pain, problems with continence and severe, frequent infection are just some of the effects of this devastating condition. Understandably, anal fistula can utterly erode the self-esteem of people who have to live their life fighting it, destroying their confidence to go about their daily life. Many patients miss months of work or school because they are either in too much pain or simply feel unable to face the outside world due to shame and embarrassment.

Many strategies and different operations are used to try and help, but the chances of success are currently far too low.

Surgeons simply don’t yet know what the best method of therapy is and successful outcomes to treatment are elusive and can take a very long time. In Crohn’s patients, fistulae are also highly like to recur or develop in more than one place.

Our researchers identified a glaring lack of good-quality research into how treatment can be improved, and even about what current treatments work the best. Their study serves as a call to arms for researchers in the field of bowel disease to drive forward work which definitely answers the question of optimum care, as well as improvements in treatment.

They are now in the process of designing a major trial to measure quality of life, known as the ENIGMA project. This work unites patients and professionals to bring about real change. We are proud that this design work is being funded by BDRF, bringing hope of lifechanging treatment into view.

You can read the review here

Systematic review of surgical interventions for Crohn’s anal fistula

Lee, M. J., Heywood, N., Adegbola, S., Tozer, P., Sahnan, K., Fearnhead, N. S., Brown, S. R. and ENiGMA Collaborators (2017), Systematic review of surgical interventions for Crohn’s anal fistula. BJS Open. doi:10.1002/bjs5.13

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