1. Inicio
  2. Publicaciones
  3. Outcomes of Medical and Surgical Therapy for Entero-urinary Fistulas in Crohn's Disease

Outcomes of Medical and Surgical Therapy for Entero-urinary Fistulas in Crohn's Disease

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Taxonera, C
  • Barreiro-de-Acosta, M
  • Martinez-Gonzalez, J
  • Merino, O
  • Garcia-Sanchez, V
  • Gisbert, JP
  • Marin-Jimenez, I
  • Lopez-Serrano, P
  • Gomez-Garcia, M
  • Iglesias, E
  • Lopez-Sanroman, A
  • Chaparro, M
  • Saro, C
  • Bermejo, F
  • Perez-Carazo, L
  • Plaza, R
  • Olivares, D
  • Alba, C
  • Mendoza, JL
  • Fernandez-Blanco, I

Grupos

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 < 0.001). 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.

Datos de la publicación

ISSN/ISSNe:
1873-9946, 1876-4479

Journal of Crohns & Colitis  OXFORD UNIV PRESS

Tipo:
Article
Páginas:
657-662
PubMed:
26786982
Factor de Impacto:
1,920 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 35

Documentos

  • No hay documentos

Métricas

Filiaciones mostrar / ocultar

Keywords

  • Crohn's disease; entero-urinary fistula; enterovesical fistula; infliximab; adalimumab; anti-TNF

Campos de Estudio

Cita

Compartir