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Title: Outcomes of Medical and Surgical Therapy for Entero-urinary Fistulas in Crohn's Disease.
Authors: Taxonera, Carlos
Barreiro-de-Acosta, Manuel
Bastida, Guillermo
Martinez-Gonzalez, Javier
Merino, Olga
García-Sánchez, Valle
Gisbert, Javier P
Marín-Jiménez, Ignacio
López-Serrano, Pilar
Gómez-García, María
Iglesias, Eva
Lopez-Sanroman, Antonio
Chaparro, María
Saro, Cristina
Bermejo, Fernando
Pérez-Carazo, Leticia
Plaza, Rocio
Olivares, David
Alba, Cristina
Mendoza, Juan L
Fernández-Blanco, Ignacio
Keywords: Crohn’s disease;adalimumab;anti-TNF;entero-urinary fistula;enterovesical fistula;infliximab
metadata.dc.subject.mesh: Adalimumab
Aged, 80 and over
Anti-Bacterial Agents
Anti-Inflammatory Agents
Case-Control Studies
Combined Modality Therapy
Crohn Disease
Follow-Up Studies
Intestinal Fistula
Middle Aged
Proportional Hazards Models
Remission Induction
Retrospective Studies
Treatment Outcome
Ureteral Diseases
Urinary Bladder Diseases
Urinary Fistula
Young Adult
Issue Date: 19-Jan-2016
Abstract: The aims of this study were to evaluate the frequency of entero-urinary fistulas in a cohort of Crohn's disease (CD) patients and to analyse the outcomes of medical and surgical therapy. This multicentre retrospective study included all CD patients with entero-urinary fistulas diagnosed by the presence of clinical symptoms and confirmed at surgery or by radiological or endoscopic techniques. We evaluated outcomes of medical and surgical therapy. We defined remission as absence of clinical symptoms with a radiological confirmation of fistula closure. Cox regression analysis was performed to evaluate factors predictive of achieving remission without need for surgery. Of 6081 CD patients screened, 97 had entero-urinary fistulas (frequency 1.6%). Seventy-five percent of fistulas occurred in men. After a median follow-up of 91 months, 96% of patients were in sustained remission. Thirty-three patients (35%) received anti-tumour necrosis factor (TNF) therapy. Of these, 45% achieved sustained remission (median follow-up 35 months) without needing surgery. More than 80% of patients required surgery, which induced remission (median follow-up 101 months) in 99% of them. Only the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12-0.44; p In this large cohort of CD patients, the frequency of entero-urinary fistulas was lower than previously described. More than 80% of patients required surgery, and in all but one of them surgery induced sustained remission. In a selected subgroup of patients, anti-TNF may induce long-term fistula remission and radiographic closure, making it possible to avoid surgery.
metadata.dc.identifier.doi: 10.1093/ecco-jcc/jjw016
Appears in Collections:Producción 2020

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