Advances in IBD

Advances in IBD

December 18, 2019
1 min read

SSNAP: Mnemonic device helps with comanagement of fistulizing Crohn’s

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ORLANDO — Management of enterocutaneous fistulas in Crohn’s disease does not always get the attention it needs, according to Anita Afzali, MD, MPH, FACG, of the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center.

“When we deal with this, we oftentimes see this as a surgical disease,” Afzali told Healio Gastroenterology and Liver Disease in an interview at AIBD. “When we just send it to our surgeons assuming they’re going to take care of it, then it becomes a struggle.”

Instead, fistula management takes a team effort and includes a few important steps to consider before surgery. To help think about these factors, Afzali uses a mnemonic device called SSNAP, which stands for Sepsis control, Skin management, Nutrition, defining the Anatomy and Procedure/operation.

Treating patients with enterocutaneous fistulas takes a special recognition that they are associated with a more severe disease phenotype, Afzali said.

“You need to be more thoughtful of what management looks like to be able to know how to address it and know what key components to focus on first,” she said.

SSNAP helps Afzali design a comanagement of these patients that includes a few important team members, including the GI, the surgeon, clinical psychologist, nutritionist and the patient themselves.

About 50% of patients with enterocutaneous fistulas on biologics will have an open fistula that requires surgery, but the device helps focus on what comes before surgery, like optimizing nutrition and selecting the right medical therapy.

“We want to define where we start, because you don’t go straight to surgery,” Afzali said. “You need to optimize all of this.” – by Alex Young


Afzali A. Case Discussion II: Management of Enterocutaneous Fistula. Presented at: Advances in Inflammatory Bowel Disease; Dec. 12-14, 2019; Orlando.

Disclosure: Afzali reports no relevant financial disclosures.