The clinical course of fistulating Crohn's disease
Open Access
- 2 May 2003
- journal article
- research article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 17 (9), 1145-1151
- https://doi.org/10.1046/j.1365-2036.2003.01561.x
Abstract
Aim : 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.Keywords
This publication has 17 references indexed in Scilit:
- The natural history of fistulizing Crohn's disease in Olmsted County, MinnesotaGastroenterology, 2002
- Infliximab for the Treatment of Fistulas in Patients with Crohn's DiseaseNew England Journal of Medicine, 1999
- Dynamic contrast-enhanced MR imaging of perianal fistulas.American Journal of Roentgenology, 1996
- Clinical course of perianal fistulas in Crohn's disease.Gut, 1995
- Management of perianal Crohn's diseaseDiseases of the Colon & Rectum, 1995
- Efficacy of cyclosporine in treatment of fistula of crohn's diseaseDigestive Diseases and Sciences, 1994
- Fistula-in-ano in Crohn's diseaseDiseases of the Colon & Rectum, 1991
- Perianal Fistulas in Patients With Crohn's DiseaseArchives of Surgery, 1986
- Favorable effect of 6-Mercaptopurine on fistulae of Crohn's diseaseDigestive Diseases and Sciences, 1985
- A classification of fistula-in-anoBritish Journal of Surgery, 1976