Carlos Taxonera1, Manuel Barreiro-de-Acosta2, Guillermo Bastida3, Javier Martinez-Gonzalez4, Olga Merino5, Valle García-Sánchez6, Javier P Gisbert7, Ignacio Marín-Jiménez8, Pilar López-Serrano9, María Gómez-García10, Eva Iglesias6, Antonio Lopez-Sanroman4, María Chaparro7, Cristina Saro11, Fernando Bermejo12, Leticia Pérez-Carazo8, Rocio Plaza13, David Olivares14, Cristina Alba14, Juan L Mendoza14, Ignacio Fernández-Blanco15. 1. Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain carlos.taxonera@salud.madrid.org. 2. Department of Gastroenterology, Hospital Clínico de Santiago, Santiago de Compostela, Spain. 3. Department of Gastroenterology, Hospital La Fe, Valencia, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain. 4. Department of Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain. 5. Department of Gastroenterology, Hospital de Cruces, Bilbao, Spain. 6. Department of Gastroenterology, Hospital Reina Sofía and IMIBIC, Universidad de Córdoba, Córdoba, Spain. 7. Department of Gastroenterology, Hospital de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain. 8. Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain. 9. Department of Gastroenterology, Hospital Alcorcón, Madrid, Spain. 10. Department of Gastroenterology, Hospital Virgen de las Nieves, Granada, Spain. 11. Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain. 12. Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain. 13. Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain. 14. Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. 15. Inflammatory Bowel Disease Unit, Hospital Moncloa, Madrid, Spain.
Abstract
BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND AND AIMS: 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. METHODS: This multicentre retrospective study included all CDpatients 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. RESULTS: Of 6081 CDpatients 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). CONCLUSION: In this large cohort of CDpatients, 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.
Authors: Shaul Yaari; Ariel Benson; Eyal Aviran; Naama Lev Cohain; Ran Oren; Jacob Sosna; Eran Israeli Journal: World J Gastroenterol Date: 2016-12-21 Impact factor: 5.742
Authors: José Francisco Tornero-Aguilera; Joaquín Sánchez-Molina; Jose A Parraca; Ana Morais; Vicente Javier Clemente-Suárez Journal: Int J Environ Res Public Health Date: 2022-08-13 Impact factor: 4.614