A Systematic Review Assessing Medical Treatment for Rectovaginal and Enterovesical Fistulae in Crohn’s Disease

Abstract

Medical therapy, alone or in combination with surgery, appears to benefit some patients with rectovaginal or enterovesical fistula. However, given the small size and low quality of the published studies, it is still difficult to draw conclusions regarding treatment. Larger, better quality studies are required to assess response to medical treatment and evaluate indications for surgery.

Anti‐TNF therapy for genital fistulas in female patients with Crohn's disease: a nationwide study from the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID)

“…It is noteworthy that our rate of complete clinical fistula closure (40%) is similar to that reported in a recent meta‐analysis (41%) . In the post hoc study of ACCENT II, among responders after induction regimen, 45.5% (5 of 11) of fistulas were closed in the infliximab maintenance group .…”

“…Thus, when one of these surgeries could be associated with an anti‐TNF agent, probability of fistula closure was two times higher than when medical treatment was used alone. This rate was higher than what was seen in the study by Kaimakliotis et al, who reported a 44.2% rate of complete response, probably because we did not consider seton drainage as a complementary surgery . However, this rate was similar to studies involving a majority of patients treated with both medical therapy and a complementary surgery .…”

“…We cannot compare our results with others treatments used independently and with others perianal fistulas. In several studies, efficacy of anti‐TNF therapy for genital fistulas is similar to entero‐enteric fistulas (HR: 0.60, 95%CI: 0.14‐2.51, P = 0.48), but is lower than for others perianal fistulas . Indeed, having a complex fistula, such as genital fistula, was shown to be a predictor of failure of anti‐TNF therapy in the study by Tozer et al (HR 0.38, 95% CI = 0.14, 0.98; P = 0.04) .…”

“…In previous case series, fistula closure varied considerably, according to the associated treatments and the definition of fistula closure . A recent meta‐analysis, including 78 patients from nine studies treated with anti‐TNF therapy for a genital fistula, reported a fistula closure rate of 41%, and a partial response in 22% of patients, with no precision about the date of evaluation . The sample size of these studies varied from 3 to 26 patients.…”

Tumor necrosis factor-alpha antibodies in fistulizing crohn's disease: An updated systematic review and meta-analysis

“…Commonly, the CD has a deteriorating course which can make patients' symptoms varied over time. [123] During recent years, CD incidence has raised up globally, and now, it is around 12.7/100,000 and 20.2./100,000 person-years in Europe and North America, respectively. Although CD can involve pediatrics and adults, it mainly affects adolescents and young adults.…”