The role of mesalazine co-treatment in the prevention of recurrence in subjects with subclinical inflammatory bowel disease and perianal fistula who are scheduled for surgical intervention.

Aim: To investigate the impact of mesalazine co-treatment in addition to the surgical intervention on recurrence rate in subjects with subclinical inflammatory bowel disease (SIBD) who present with perianal fistula (PAF).

Materials And Methods: All consecutive patients who had undergone surgery for PAF in our institutes were included in this retrospective analysis. Ileal tissue samples were obtained during colonoscopy for pathological evaluation. Patients with active chronic ileitis, structural distortion, erosion, ulceration, cryptitis, crypt abscess, fibrosis, and Paneth cell hyperplasia were defined as SIBD. Patients were divided into two groups according to the presence or absence of SIBD on pathological evaluation of ileal tissue samples (Group 1: SIBD +; Group 2: SIBD -). Rectal 5-aminosalicylic acid (mesalazine) of 2 gr once daily was administered to half of the subjects in each group for 8 weeks. The difference in 6 months recurrence rates of subjects receiving or not receiving mesalazine was the primary outcome measure.

Results: The overall recurrence rate of subjects not receiving mesalazine was significantly higher than that of the subjects receiving mesalazine (9.7% vs. 4.4%, p = 0.020). Recurrence rate of the subjects with SIBD who received mesalazine co-treatment was significantly lower than those without mesalazine (1.6% vs. 12.6%, p=0.002). However, recurrence rate of the subjects without SIBD who received and not received mesalazine co-treatment was similar (6.8% vs. 7.8%, p=0.764).

Conclusion: Mesalazine co-treatment in addition to the surgical intervention was associated with lower 6 months recurrence rate compared to surgical intervention alone in patients with SIBD and PAF.

Key Words: Inflammatory bowel disease, Mesalazine, Perianal fistula.