“…Although enterocutaneous fistulas may be secondary to surgery in CD patients, most commonly they occur spontaneously as a consequence of an underlying bowel inflammation. 21, 22 Enterocutaneous fistulas are commonly associated with malnutrition as a consequence of fistula output, wound infection, and coexisting sepsis. 21, 23 Enterocutaneous fistulas rarely respond to medical treatment, 21, 22 and, as a consequence, the majority of patients need surgical intervention and resection.…”
BackgroundFistulas may arise as a relevant complication of Crohn’s disease (CD). Despite their clinical significance and the substantial burden imposed on patients, limited data are available on the epidemiology of fistulizing CD in the United States.MethodsA systematic literature review was conducted to identify data published between 1970 and 2017 on the epidemiology of fistulas in patients with CD, with the aim to estimate the number of prevalent cases in the United States. Retrieved titles and abstracts were screened by 2 independent researchers for inclusion criteria (US population-based studies reporting data on the epidemiology of fistulizing CD). To validate the literature-based estimate, data from a US claims database (Truven Health MarketScan database) were analyzed. This database has broad geographic coverage, with health care data for >60 million patients during the period of the analysis.ResultsThe literature search retrieved 7 articles for full-text review, and only 1 met the criteria for inclusion. This study described the cumulative incidence of fistulas in a CD population from Minnesota over 20 years. From the reported data, the estimated number of prevalent cases with fistulizing CD in the United States was ~76,600 in 2017 (~52,900 anal, ~7400 rectovaginal, ~2300 enterocutaneous, and ~14,100 internal). Analysis from the US health care database resulted in an estimated number of ~75,700 patients, confirming the robustness of the original estimate from the literature.ConclusionsBased on 2 separate analyses, the estimated number of patients with fistulizing CD in the United States is ~77,000 patients.
“…Although enterocutaneous fistulas may be secondary to surgery in CD patients, most commonly they occur spontaneously as a consequence of an underlying bowel inflammation. 21, 22 Enterocutaneous fistulas are commonly associated with malnutrition as a consequence of fistula output, wound infection, and coexisting sepsis. 21, 23 Enterocutaneous fistulas rarely respond to medical treatment, 21, 22 and, as a consequence, the majority of patients need surgical intervention and resection.…”
BackgroundFistulas may arise as a relevant complication of Crohn’s disease (CD). Despite their clinical significance and the substantial burden imposed on patients, limited data are available on the epidemiology of fistulizing CD in the United States.MethodsA systematic literature review was conducted to identify data published between 1970 and 2017 on the epidemiology of fistulas in patients with CD, with the aim to estimate the number of prevalent cases in the United States. Retrieved titles and abstracts were screened by 2 independent researchers for inclusion criteria (US population-based studies reporting data on the epidemiology of fistulizing CD). To validate the literature-based estimate, data from a US claims database (Truven Health MarketScan database) were analyzed. This database has broad geographic coverage, with health care data for >60 million patients during the period of the analysis.ResultsThe literature search retrieved 7 articles for full-text review, and only 1 met the criteria for inclusion. This study described the cumulative incidence of fistulas in a CD population from Minnesota over 20 years. From the reported data, the estimated number of prevalent cases with fistulizing CD in the United States was ~76,600 in 2017 (~52,900 anal, ~7400 rectovaginal, ~2300 enterocutaneous, and ~14,100 internal). Analysis from the US health care database resulted in an estimated number of ~75,700 patients, confirming the robustness of the original estimate from the literature.ConclusionsBased on 2 separate analyses, the estimated number of patients with fistulizing CD in the United States is ~77,000 patients.
“…Unfortunately, interpretation of cross-sectional imaging studies shortly after IBD surgery is generally difficult due to a combination of limited intra-abdominal fat and of postoperative changes such as diffuse oedema at resection site and in the mesentery, peritoneal fluid, and CM enhancement; in our experience this is particularly true with MRI (Fig. 11 D–F) [ 15 , 16 ]. Fig.…”
Section: Enterocutaneous Fistulas In Chronic Inflammatory Bowel Diseamentioning
confidence: 99%
“…In the vast majority of cases, ECFs arise from the diseased distal ileum and are associated with long-standing or active fistulising CD; exceptionally, an ECF may be the initial manifestation of an undiagnosed IBD. Albeit uncommon, CD still represents the main cause of non-iatrogenic ECFs and should therefore be suspected in a non-healing spontaneous fistula in a young or middle-aged, otherwise healthy patient [ 15 , 16 ].…”
Section: Enterocutaneous Fistulas In Chronic Inflammatory Bowel Diseamentioning
confidence: 99%
“…In the last decade, medical therapy changed with introduction of biologics and immunomodulators. Following experience with perianal inflammatory disease, monoclonal antibodies against tumour necrosis factor are increasingly used: with correct patient selection, in the absence of stenosis and complex fistulas, infliximab achieves good response in postoperative and, to a minor extent, spontaneous ECFs too [ 16 , 21 , 22 ].…”
Section: Enterocutaneous Fistulas In Chronic Inflammatory Bowel Diseamentioning
Enterocutaneous fistulas (ECFs) represent abnormal communications between the gastrointestinal tract and the skin. Nowadays, the majority (~80%) of ECFs develops secondary to abdominal surgeries; alternative, less common causes include chronic inflammatory bowel diseases (IBD) such as Crohn’s disease, tumours, and radiation enteritis in descending order of frequency. These rare disorders require thorough patient assessment and multidisciplinary management to limit the associated morbidity and mortality. This pictorial review includes an overview of causes, clinical manifestations, complications and management of ECFs. Afterwards, the imaging appearances, differential diagnoses, and therapeutic options of post-surgical, IBD-related, and malignant ECFs are presented with case examples. Most of the emphasis is placed on the current pivotal role of CT and MRI, which comprehensively depict ECFs providing cross-sectional information on the underlying postsurgical, neoplastic, infectious, or inflammatory conditions. Radiographic fistulography remains a valid technique, which rapidly depicts the ECF anatomy and confirms communication with the bowel. The aim of this paper is to increase radiologists’ familiarity with ECF imaging, thus allowing an appropriate choice between medical, interventional, or surgical treatment, ultimately resulting in higher likelihood of therapeutic success.Teaching Points• Enterocutaneous fistulas may complicate abdominal surgery, sometimes Crohn’s disease and tumours.• The high associated morbidity and mortality result from sepsis, malnutrition and metabolic imbalance.• The multidisciplinary management of ECFs requires thorough imaging for correct therapeutic choice.• Radiographic fistulography rapidly depicts fistulas and communicating bowel loops in real-time.• Multidetector CT and MRI provide cross-sectional information on fistulas and underlying diseases.
“…25 Similar to that, a Spanish study demonstrated that the use of anti-TNF resulted in complete healing in only 3 out of 24 enteric CD fistula patients. 26…”
Section: Medical Management: Anti-tnf Drugs and Enteric Fistulasmentioning
Crohn's disease is a chronic, inflammatory bowel condition that can affect the entire digestive tract and in many cases lead to enteric fistula formation. The management of enteric fistulas can be challenging and often requires a multidisciplinary approach.
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