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Table of Contents
Vol. 76, No. 2, 2007
Issue release date: February 2008
Digestion 2007;76:109–112
(DOI:10.1159/000111024)

Fistulizing Crohn’s Disease

Felley C. · Mottet C. · Juillerat P. · Pittet V. · Froehlich F. · Vader J.-P. · Michetti P. · Gonvers J.-J.
aDivision of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, bGastrointestinal Department, University of Basle, Basle, and cHealthcare Evaluation Unit, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland

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Abstract

Fistulas are common in Crohn’s disease. A population-based study has shown a cumulative risk of 33% after 10 years and 50% after 20 years. Perianal fistulas were the most common (54%). Medical therapy is the main option for perianal fistula once abscesses, if present, have been drained, and should include antibiotics (both ciprofloxacin and metronidazole) and immunomodulators. Infliximab should be reserved for refractory patients. Surgery is often necessary for internal fistulas.



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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB: AGA technical review on perianal Crohn’s disease. Gastroenterology 2003;125:1508–1530.
  2. Felley C, Mottet C, Juillerat P, Froehlich F, Burnand B, Vader JP, Michetti P, Gonvers JJ: Fistulizing Crohn’s disease. Digestion 2005;71:26–28.
  3. Steinberg DM, Cooke WT, Alexander-Williams J: Abscess and fistulae in Crohn’s disease. Gut 1973;14:865–869.
  4. Farmer RG, Hawk WA, Turnbull RB Jr: Clinical patterns in Crohn’s disease: a statistical study of 615 cases. Gastroenterology 1975;68:627–635.
  5. Rankin GB, Watts HD, Melnyk CS, Kelley ML Jr: National Cooperative Crohn’s Disease Study: extraintestinal manifestations and perianal complications. Gastroenterology 1979;77:914–920.
  6. Hellers G, Bergstrand O, Ewerth S, Holmstrom B: Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut 1980;21:525–527.
  7. Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, Sandborn WJ: The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 2002;122:875–880.
  8. Bernstein LH, Frank MS, Brandt LJ, Boley SJ: Healing of perineal Crohn’s disease with metronidazole. Gastroenterology 1980;79:357–365.
  9. Brandt L, Bernstein L, Boley S, Frank M: Metronidazole therapy for perineal Crohn’s disease: a follow-up study. Gastroenterology 1982;83:383–387.
  10. Turunen U, Farkkila M, Valtonen V, Seppala K: Long-term outcome of ciprofloxacin treatment in severe perianal or fistulous Crohn’s disease. Gastroenterology 1993;104:A793.

    External Resources

  11. Solomon M: Combination of ciprofloxacine and metronidazole in severe perianal Crohn’s disease. Clin Invest Med 1992;15:A41.
  12. Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS: Treatment of Crohn’s disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med 1980;302:981–987.
  13. Korelitz BI, Present DH: Favorable effect of 6-mercaptopurine on fistulae of Crohn’s disease. Dig Dis Sci 1985;30:58–64.
  14. Pearson DC, May GR, Fick GH, Sutherland LR: Azathioprine and 6-mercaptopurine in Crohn’s disease – a meta-analysis. Ann Intern Med 1995;123:132–142.
  15. Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ: Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999;340:1398–1405.
  16. Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ: Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 2004;350:876–885.
  17. Sands BE, Blank MA, Patel K, van Deventer SJ: Long-term treatment of rectovaginal fistulas in Crohn’s disease: response to infliximab in the ACCENT II study. Clin Gastroenterol Hepatol 2004;2:912–920.
  18. Lichtenstein GR, Yan S, Bala M, Blank M, Sands BE: Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn’s disease. Gastroenterology 2005;128:862–869.
  19. Mahadevan U, Marion JF, Present DH: Fistula response to methotrexate in Crohn’s disease: a case series. Aliment Pharmacol Ther 2003;18:1003–1008.
  20. Present DH, Lichtiger S: Efficacy of cyclosporine in treatment of fistula of Crohn’s disease. Dig Dis Sci 1994;39:374–380.
  21. Hanauer SB, Smith MB: Rapid closure of Crohn’s disease fistulas with continuous intravenous cyclosporin A. Am J Gastroenterol 1993;88:646–649.
  22. Egan LJ, Sandborn WJ, Tremaine WJ: Clinical outcome following treatment of refractory inflammatory and fistulizing Crohn’s disease with intravenous cyclosporine. Am J Gastroenterol 1998;93:442–448.
  23. Sandborn WJ, Present DH, Isaacs KL, Wolf DC, Greenberg E, Hanauer SB, Feagan BG, Mayer L, Johnson T, Galanko J, Martin C, Sandler RS: Tacrolimus for the treatment of fistulas in patients with Crohn’s disease: a randomized, placebo-controlled trial. Gastroenterology 2003;125:380–388.
  24. Williamson PR, Hellinger MD, Larach SW, Ferrara A: Twenty-year review of the surgical management of perianal Crohn’s disease. Dis Colon Rectum 1995;38:389–392.
  25. Faucheron JL, Saint-Marc O, Guibert L, Parc R: Long-term seton drainage for high anal fistulas in Crohn’s disease – a sphincter-saving operation? Dis Colon Rectum 1996;39:208–211.
  26. Schwartz DA, Pemberton JH, Sandborn WJ: Diagnosis and treatment of perianal fistulas in Crohn’s disease. Ann Intern Med 2001;135:906–918.


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