The clinical course of fistulating Crohn's disease

Abstract

SUMMARYAim: To determine the clinical characteristics, management and outcome of Crohn's fistulas from the time of first presentation. Methods: Patients treated for fistulas 6 years previously were assessed for disease demographics, fistula characteristics and treatment from first presentation to final follow-up. Results: Eighty-seven patients with active Crohn's fistulas were evaluated. The median age was 35 years and the median duration of Crohn's disease was 8 years at study entry. Disease was ileo-colonic or colonic in 85%, and 65% had rectal involvement. A single fistula was present in one-third and multiple fistulas in two-thirds; 65% of fistulas were perianal; 80% of fistulas were complex. After a median follow-up from the last treatment of 5.9 years, 68% of patients showed healing of all fistulas, 18% showed healing of some fistulas and 14% showed no healing of fistulas. The fistula site did not influence healing. Perianal and recto-vaginal fistulas took a median of 2.6 years to heal. Half of the complex fistulas required a stoma, resection or proctectomy. Conclusions: Healing is usually achieved. However, morbidity is great and healing is slow. Proctectomy is required in one-fifth of patients, and perineal healing is often slow. Defining the perianal fistula anatomy as complex or simple determines the likelihood of healing and the type of surgical approach required.

Sensitivity and Specificity of Magnetic Resonance Enterography in the Clinical Management of Fistulizing Crohnʼs Disease

“…Fistulae are frequent problems in patients with Crohn's disease (CD). The reported incidence ranges from 17% up to 50%, [1][2][3][4] and population-based studies support the higher figures. 5 Internal fistulae have been classified clinically into 2 types: those which form an internal connection between 2 bowel segments and those that occur between the intestine and other organs, such as the bladder (enterovesical) or abdominal wall (enterocutaneous).…”

CARD15 Mutations and Perianal Fistulating Crohn’s Disease: Correlation and Predictive Value of Antibiotic Response

“…In contrast, a complex fistula is located high (high transsphincteric, extrasphincteric or suprasphincteric), may be associated with pain, can potentially involve multiple external openings, and may be associated with rectovaginal fistula and/or anorectal stricture [6]. This is a clinically important differentiation, because several studies have shown better outcomes for patients with simple fistula tracts [7][8][9][10].…”

“…Furthermore, ineffective or inappropriate treatment of perianal fistula may lead to recurrence of the fistula or can result in the fistula progressing from simple to complex form [17]. Complex fistulas are more difficult to treat, have decreased healing rates, and are associated with less successful outcomes [7][8][9][10]. For these reasons, it would be very important to have predictors of the response of perianal fistulas to antibiotics.…”

Clinical Example of Efficiency of the Multidisciplinary Approach to the Management of a Patient with Crohn's Disease Complicated by Perianal Lesions

“…Лишь в ходе наблюдения стало очевидным нали-чие перианального пора-жения с формированием свища и параректальных абсцессов. Ведение паци-ента с болезнью Крона с перинальным пораже-нием требует несколько других подходов: отказа от аналогов естественных гормонов в связи с высо-ким риском гнойных и септических осложнений, длительного использования антибиотиков, раннего назначения иммуносупрессивной терапии, совместного ведения пациента гастроэнтероло-гом и хирургом [19,22]. Согласно последнему консенсусу ECCO по ведению болезни Крона у детей, при перианаль-ном поражении анти-TNF терапия может рассматривать-ся в качестве терапии первой линии (индукция и под-держание ремиссии) и должна осуществляться совместно с хирургическим лечением [20].…”