Taku Kobayashi1, Asahi Hishida, Hiroki Tanaka, Yoichiro Nuki, Shigeki Bamba, Akihiro Yamada, Toshimitsu Fujii, Shinichiro Shinzaki, Yoko Yokoyama, Atsushi Yoshida, Keiji Ozeki, Shinya Ashizuka, Noriko Kamata, Sohachi Nanjo, Kazuki Kakimoto, Misaki Nakamura, Akira Matsui, Ryosuke Yamauchi, Sakuma Takahashi, Taku Tomizawa, Takuya Yoshino, Toshifumi Hibi. 1. 1Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan; 2Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; 3IBD Center, Sapporo Kosei General Hospital, Sapporo, Japan; 4Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; 5Department of Medicine, Shiga University of Medical Science, Shiga, Japan; 6Department of Internal Medicine, Sakura Medical Center, Toho University, Chiba, Japan; 7Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan; 8Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan; 9Department of Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan; 10Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan; 11Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 12Circulatory and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; 13Department of Gastroenterology Osaka City University Graduate School of Medicine, Osaka, Japan; 14Department of Gastroenterology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan; 15Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan; 16Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Mie, Japan; 17Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan; 18Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan; 19Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan; 20Department of Gastroenterology and Hepatology, Gunma University, Gunma, Japan; and 21Division of Inflammatory Bowel Disease, Digestive Disease Center, Kitano Hospital, Osaka, Japan.
Abstract
BACKGROUND: Internal fistula in Crohn's disease is a condition likely to require surgery, although few reports showed successful medical treatments such as anti-tumor necrosis factor (TNF) therapy. We performed a multicenter retrospective cohort study to investigate the outcome of anti-TNF therapy for internal fistula in Crohn's disease. METHODS: Data were retrospectively collected from patients with Crohn's disease diagnosed with internal fistula treated with anti-TNF agents (infliximab or adalimumab) between January 2002 and November 2015. Need for surgery and fistula closure were assessed as primary and secondary endpoints. Cumulative rate of surgery was evaluated by the Kaplan-Meier analysis. Prognostic factors for the outcomes were also assessed by univariate and multivariate analyses. RESULTS: A total of 93 Crohn's disease cases were included in the study with a mean follow-up period of 1452.8 days. Fistula locations were entero-entero/colonic (n = 72, 77.4%), enterovesical (n = 16, 17.2%), or enterovaginal (n = 5, 5.4%). Cumulative surgery rate was 47.2%, and fistula closure rate was 27.0% at 5 years from the induction of anti-TNF agents. Lower Crohn's Disease Activity Index and shorter duration from the diagnosis of fistula were independently associated with the lower risk of surgery (P = 0.017 and 0.048, respectively). Single fistula was associated with the successful fistula closure. Second-line surgical treatments were mostly successful for anti-TNF failures. CONCLUSIONS: In the present retrospective cohort study, approximately half of patients with internal fistulas avoided surgery for long periods. It may be reasonable to treat quiescent single internal fistulas with anti-TNF agents soon after the diagnosis of internal fistulas.
BACKGROUND:Internal fistula in Crohn's disease is a condition likely to require surgery, although few reports showed successful medical treatments such as anti-tumor necrosis factor (TNF) therapy. We performed a multicenter retrospective cohort study to investigate the outcome of anti-TNF therapy for internal fistula in Crohn's disease. METHODS: Data were retrospectively collected from patients with Crohn's disease diagnosed with internal fistula treated with anti-TNF agents (infliximab or adalimumab) between January 2002 and November 2015. Need for surgery and fistula closure were assessed as primary and secondary endpoints. Cumulative rate of surgery was evaluated by the Kaplan-Meier analysis. Prognostic factors for the outcomes were also assessed by univariate and multivariate analyses. RESULTS: A total of 93 Crohn's disease cases were included in the study with a mean follow-up period of 1452.8 days. Fistula locations were entero-entero/colonic (n = 72, 77.4%), enterovesical (n = 16, 17.2%), or enterovaginal (n = 5, 5.4%). Cumulative surgery rate was 47.2%, and fistula closure rate was 27.0% at 5 years from the induction of anti-TNF agents. Lower Crohn's Disease Activity Index and shorter duration from the diagnosis of fistula were independently associated with the lower risk of surgery (P = 0.017 and 0.048, respectively). Single fistula was associated with the successful fistula closure. Second-line surgical treatments were mostly successful for anti-TNF failures. CONCLUSIONS: In the present retrospective cohort study, approximately half of patients with internal fistulas avoided surgery for long periods. It may be reasonable to treat quiescent single internal fistulas with anti-TNF agents soon after the diagnosis of internal fistulas.
Authors: Brad D Constant; Edwin F de Zoeten; Jason P Weinman; Lindsey Albenberg; Frank I Scott Journal: Dig Dis Sci Date: 2022-07-05 Impact factor: 3.487