Year 2013 / Volume 105 / Number 1
Original
Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment

pp. 3-6

Silvia Gómez Senent, Manuel Barreiro-de Acosta y Valle García-Sánchez

Abstract
Introduction: the low prevalence of enterocutaneous fistulas (ECF) in patients with Crohn’s disease (CD) justifies the scarcity of studies that analyze the effect of medical treatment and the need for surgery in these patients. The objective of this study was to eva- luate the clinical characteristics of patients with CD who have ECF and the response to different treatments.

Material and methods: patients with CD who presented ECF fistula between 1970 and 2009 in three tertiary centers in Spain were analyzed retrospectively for their clinical characteristics, res- ponse to treatment as well as the correlation between the response to biological therapies for ECF and perianal disease. The inflamma- tory activity of the disease was measured using the Harvey-Bradshaw index. The definitions of partial or complete response were based on the treating physician’s judgment.

Results: twenty six patients were included (18 women); in more than half of cases (67%), anti-TNF treatment improved fistula drai- nage. Postoperative fistulas responded better to anti-TNF treatment than did spontaneous fistulas (80 versus 57%). One hundred percent and 60% of spontaneous and postoperative fistulas closed after sur- gery, respectively.

Conclusions: although the majority of patients required surgery as the ultimate treatment, anti-TNF drugs improved fistula output in an acceptable percentage of patients who were treated. Therefore, this may be a treatment strategy prior to surgery in a select group of patients.
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Silvia Gómez Senent, Manuel Barreiro-de Acosta y Valle García-Sánchez. Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment. 3-6


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