New therapy for Crohn's disease in Debrecen

Stem cell therapy is now available at the University of Debrecen Clinical Centre for the treatment of rectal fistula in patients with Crohn's disease. The procedure is a huge step forward, as it can even make the disease curable, which has not been possible with other treatments.

The number of people suffering from inflammatory bowel diseases, including Crohn's disease, has been gradually increasing over the past decades. The Gastroenterology Clinic of the University of Debrecen is one of the largest centres of excellence in the country with one of the largest patient volumes in this field. Around 1,500 inflammatory bowel patients are treated at the institution. Experience has shown that thirty to forty percent of patients with inflammatory bowel disease - primarily Crohn's disease - develop rectal inflammation, with the presence of an anal fistula being a major abnormality, which significantly affects quality of life.  

- In itself, an anal fistula with secretions, in addition to potentially serious anatomical complications, is a significant psychological burden that has a negative impact on patients' daily life. Due to the nature and location of the lesion, patients are often late in seeking medical attention and are therefore more likely to develop complications. In order to increase the effectiveness of treatment, different surgical options are important in addition to and in coordination with conservative treatment. In this respect, mesenchymal stem cell transplantation is of particular importance," said Mária Papp, Professor and Director of the Gastroenterology Clinic of the University of Debrecen Clinical Centre.

Stem cell therapy for the treatment of anal fistula was introduced at the Department of Surgery of the University of Debrecen Clinical Centre last summer. The procedure can achieve a complete cure, which was not possible with other therapies until now. Patients treated at the Department of Gastroenterology are referred to the Proctology Ambulance of the Department of Surgery, where, if a fistula is confirmed, they are examined to see if they meet the strict criteria for stem cell therapy. Among other things, the patient must have received biological therapy for at least six months beforehand, and the type of fistula passage is also specified. The feasibility of the treatment is also influenced by the type of fistula passage.

- In the past 10-15 years, surgical options have included cleaning the fistula passages or inserting threads called setons to keep them clear, but there has been no chance of a permanent cure. Stem cell therapy is a huge step forward, it has given us an opportunity to cure patients. If the patient is suitable for the treatment based on the strict criteria, the cure rate can be around forty-five to fifty percent," added Péter Kolozsi, head of the proctology working group at the University of Debrecen Clinical Centre, Department of Surgery.

The stem cells are produced to order in Madrid and then transported to the University of Debrecen Pharmacy at a specific temperature, under constant control, and from there to the Surgery Clinic for the procedure.

- The four ampoules are injected into the wall of the fistula or around its orifices, where the stem cells are transformed into connective tissue cells to heal the fistula. The procedure itself is quite simple. A great deal more work is required to screen the patient according to a selective set of criteria," said Péter Kolozsi.

Six months after the operation, a pelvic MRI scan is performed to check whether the operation has fully healed. Continuous monitoring of the patient's condition is important afterwords, too.  Close collaboration between the gastroenterologist and the surgeon is required at all times. 

- We have an up-to-date connection with the Department of Gastroenterology and communication is perfect. This is one of the reasons why the University of Debrecen was selected as one of the centres where such stem cell therapy is possible," said Dezső Tóth, Associate Professor and Director of the Department of Surgery at the University of Debrecen Clinical Centre.

Stem cell therapy as a novel treatment modality has a role in the treatment of so-called complex fistulas, together with biological and antibiotic treatment as needed.

The University of Debrecen Clinical Centre also has a multidisciplinary team of gastroenterologists, surgeons and radiologists who meet weekly to discuss treatment options for patients with inflammatory bowel disease, ensuring the most appropriate and effective treatment for them.

Press Centre  - CzA