Chrones Disease and Perianal Fistulas

So what is a Fistula?

Fistulas are pretty common in people who have Chrones Disease and the basic definition is that they are abnormal connections or passageways between organs or vessels that should not normally connect to each other.

What Are Perianal Fistulas?

A perianal fistula is a abnormal connection between the anus and rectum with another organ or vessel such as the skin or the vagina.

According to research about 12 percent of people with chrones disease have Perianal fistulas, this is a huge amount as there are said to be at least half a million people with Crohn's disease in the US alone. Anal fistulas can lead to a big drop in the quality of life for anyone who has them as they can cause anal incontinence and infections.

How are Fistulas treated?

Surgery
Surgery is currently the main form of treatment, which is invasive as well as having a fairly poor success rate.

Anti TNF-alpha and drugs like Remicade (Infliximab) are also now used. The success rate of this treatment varies from patient to patient.

Cx401 (Still in development)
Cx401 is an non-embryonic (autologous) stem cell product developed by Cellerix from human adipose tissue. This autologous source offers clear advantages over other alternatives such as bone-marrow, including easier access to the stem cells and higher yield (100 to 1,000 times). Using a minimal amount of fat drawn from the patient, it is possible to obtain stem cells that have an extraordinary capacity to facilitate the healing process of fistulas.

How will the CX401 treatment work?
The treatment consists of the extraction, expansion and re-administration of the patient's own cells into the area that has fistulas. The natural healing of the fistula tract is achieved through the anti-inflammatory properties of Cx401.

So far there have been excellent clinical results obtained to date with the product. In a study to evaluate feasibility and safety of Cx401, it was confirmed that it has the potential to treat fistulas in Chrones Disease patients and showed a 75% response rate only 8 weeks after the initial treatment.

Chrones Disease and Pregnancy

Because chrones disease often affects women of child-bearing age, I thought I would take a look at what the complications are of having Chrones disease whilst pregnant:

Risk of an early Birth
There have been some recent studies carried out at the Aarhus University Hospital in Denmark by Dr. Bente Norgard and what they have shown that having an active chrones disease (a flare-up) during your pregnancy raises the risk of having a pre-term birth. This risk was shown to be three times higher in women with active chrones disease.

The researchers looked at the impact of chrones disease in 86 women with inactive Chrones disease during pregnancy (chrones in remission) and 71 women who had low to moderately high active chrones disease during their pregnancy.


What they also found is that women with the active chrones disease during their pregnancy, were shown the risks of giving birth to a child of low birth weight and congenital abnormalities were not increased, compared to the women with inactive chrones disease.

Overall the best advice is if you have crohn's disease and you are wanting to have a baby is to first get the disease under control and in remission. It is also important to work closely with your doctors who will be able to advise you and to point out the medications that you can and cannot take during the pregnancy.

SOURCE: American Journal of Gastroenterology, September 2007.