Year 2021 / Volume 113 / Number 4
Original
Treatment of abdominal fistulas in Crohn’s disease and monitoring with abdominal ultrasonography

240-245

DOI: 10.17235/reed.2020.6884/2020

Nadia Moreno Sánchez, José María Paredes, Tomas Ripollés, Javier Sanz de la Vega, Patricia Latorre, María Jesús Martínez, José Richart, José Vizuete, Eduardo Moreno-Osset,

Abstract
Objective: to assess the usefulness of medical treatment to achieve closure of internal fistulas detected on abdominal ultrasound in a series of patients with fistulizing Crohn’s disease. Material and methods: a retrospective analysis was performed of the medical records of patients with Crohn’s disease with a fistula detected on abdominal ultrasound from 2010 to 2018. The study included patients who received medical treatment after the diagnosis of this complication and underwent ultrasonographic monitoring of the therapeutic response. The factors associated with the response to medical treatment or the need for surgery were investigated. Results: forty-six patients were included in the study. Enteromesenteric (69.6 %) was the most common type of fistula and associated abscesses were found in 14 (30.4 %) patients. Fistulas were classified as complex in 20 patients. Treatment with immunosuppressants was started in 14 (30.4 %) cases and a biologic drug was added in 18 (39.1 %) patients. Complete closure of the abdominal fistula was observed with ultrasonography in 24 (52.2 %) of the 46 patients. The only factor related to fistula closure was the type of fistula and was more likely to occur in patients with an enteromesenteric fistula. Thirteen (28 %) of the 46 patients needed a surgical resection. The only factor with a significant correlation with a lower need for surgery was fistula closure after treatment (8.3 % vs 50 %, p = 0.002). Conclusion: medical treatment achieves internal fistula closure in more than half of cases and almost a third require surgical treatment. Abdominal ultrasound can detect abdominal fistulas at an earlier stage and allow prompt treatment changes.
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16/09/2022 14:10:33


References
1- Levy C, Tremaine WJ. Management of internal fistulas in Crohn´s disease. Inflamm Bowel Dis 2002;8:106-111.
2- Greenstein AJ, Kark AE, Dreiling DA. Crohn´s disease of the colon. I. Fistula in Crohn´s disease of the colon, classification presenting features and management in 63 patients. Am J Gastroenterol 1974;62:419-29
3- Schwartz DA, Loftus EV, Tremaine WJ, et al. The natural history of fistulizing Crohn´s disease in Olmsted, Minnesota. Gastroenterology 2002;122:875-880.
4- Panés J, Bouzas R, Chaparro M, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther. 2011;34:125-45.
5- Panés J, Bouhnik Y, Reinisch W, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013;7:556-85.
6- Present DH, Rutgeerts P, Targan S. Infliximab for the treatment of fistulas in patients with Crohn´s disease. N Engl J Med 1999;340:1398-405.
7- Sands BE, Anderson FH, Bernstein CN. Infliximab maintenance therapy for fistulising Crohn´s disease. N Engl J Med 2004;350:876-85.
8- Colombel IF, Schwartz DA, Sandborn WJ. Adalimumab for the treatment of fistulas in patients with Crohn´s disease. Gut 2009;58:940-8.
9- Glass RE, Ritchie JK, Lennard-Jones JE, et al. Internal fistulas in Crohn´s disease. Dis Colon Rectum 1985;28:557-561.
10- Nunes J, Santos PM, Tavares L. Complete resolution of enterocolic fistulas with infliximab. Biodrugs 2010;24:28-30.
11- Jeong SY, Moon JS, Park KJ, et al. Successful treatment of postoperative fistula with infliximab in a patient with Crohn´s disease. Intest Res 2014;12:74-77.
12- Uza N, Nakase H, Ueno S, et al. The effect of medical treatment on patients with fistulizing Crohn's disease: a retrospective study. Intern Med. 2008;47:193-9.
13- Amiot A, Setakhr V, Seksik P, et al. Long-term outcome of enterocutaneus fistula in patients with Crohn´s disease treated with anti-TNF therapy: a cohort study from the GETAID. Am J Gastroenterol 2014;109:1443-49.
14- Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol 1989;24:2-6.
15- Moreno N, Ripollés T, Paredes JM, et al. Usefulness of abdominal ultrasonography in the analysis of endoscopic activity in patients with Crohn's disease: changes following treatment with immunomodulators and/or anti-TNF antibodies. J Crohns Colitis. 2014;8:1079-87.
16- Martínez MJ, Ripollés T, Paredes JM, et al. Assessment of the extension and the inflammatory activity in Crohn's disease: comparison of ultrasound and MRI. Abdom Imaging. 2009;34:141-8.
17- Maconi G, Radice E, Greco S, et al. Bowel ultrasound in Crohn's disease. Best Pract Res Clin Gastroenterol. 2006;20:93-112.
18- Herrmann KA, Michaely HJ, Zech CJ, et al. Internal fistulas in Crohn disease: Magnetic Resonance enteroclysis. Abdom Imaging. 2006;31:675-87.
19- Rimola J, Ordás I, Rodríguez S, et al. Colonic Crohn's disease: value of magnetic resonance colonography for detection and quantification of disease activity. Abdom Imaging. 2010;35:422-7.
20- Ripollés T, Martínez-Pérez MJ, Paredes JM, et al. Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions. Eur J Radiol. 2013;82:525-31.
21- Maconi G, Sampietro GM, Parente F, et al. Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn's disease: a prospective comparative study. Am J Gastroenterol. 2003;98:1545-55
22- Booya F, Akram S, Fletcher JG, et al. CT enterography and fistulizing Crohn's disease: clinical benefit and radiographic findings. Abdom Imaging. 2009;34:467-75.
23- Clark M, Colombel JF, Feagan BC, et al. American gastroenterological association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21-23, 2006. Gastroenterology 2007;133:312-39.
24- Cullen G, Vaughn B, Ahmed A, et al. Abdominal phlegmons in Crohn's disease: outcomes following antitumor necrosis factor therapy. Inflamm Bowel Dis. 2012;18:691-6.
25- Ibáñez-Samaniego L, Díaz-Fontenla F, Miranda-Bautista J, et al. Safety and Efficacy of Anti-TNFα Treatment in Crohn's Disease Patients with Abdominal Abscesses. Hepatogastroenterology. 2015;62:647-52.
26- Parsi MA, Lashner BA, Achkar JP, et al. Type of fistula determines response to infliximab in patients with fistulous Crohn's disease. Am J Gastroenterol 2004;99:445-9.
27- Taxonera C, Barreiro-de-Acosta M, Bastida G, et al. Outcomes of Medical and Surgical Therapy for Entero-urinary Fistulas in Crohn's Disease. J Crohns Colitis. 2016;10(6):657-62.
28- Paredes JM, Ripollés T, Cortés X, et al. Abdominal sonographic changes after antibody to tumor necrosis factor (anti-TNF) alpha therapy in Crohn's Disease. Dig Dis Sci. 2010;55:404-10.
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Moreno Sánchez N, Paredes J, Ripollés T, Sanz de la Vega J, Latorre P, Martínez M, et all. Treatment of abdominal fistulas in Crohn’s disease and monitoring with abdominal ultrasonography. 6884/2020


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Publication history

Received: 15/01/2020

Accepted: 04/05/2020

Online First: 23/11/2020

Published: 07/04/2021

Article revision time: 102 days

Article Online First time: 313 days

Article editing time: 448 days


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