Medical therapy, not surgery, is the appropriate first line treatment for Crohn's enterovesical fistula

Wheeler, SC; Marion, JF; Present, D.

doi:10.1016/s0016-5085(98)84526-5

Cited by 30 publications

(12 citation statements)

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“…In a study that examined the effect of azathioprine and 6-mercaptopurine therapy on enterovesical fistulas, 18 of 31 patients (58%) responded to treatment, and 12 of these patients maintained their response throughout followup (mean 8.1 years, range 0.6-17.4 years). 46 In another study, 9 of 12 patients (75%) responded to 6-mercaptopurine treatment after a minimum of 3 months of therapy. 47 In a small study that included eight patients, fistula closure was observed after a minimum of 3 months of treatment in two patients who were treated solely with 6-mercaptopurine.…”

Section: Glucocorticoidsmentioning

confidence: 95%

Diagnosis and management of fistulizing Crohn's disease

Nielsen

Rogler

Hahnloser

et al. 2009

Nat Rev Gastroenterol Hepatol

113

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The transmural inflammation characteristic of Crohn's disease predisposes patients to the formation of fistulas. Up to 50% of patients with Crohn's disease are affected by fistulas, which is a major problem given the considerable morbidity associated with this complication. Appropriate treatment of fistulas requires knowledge of specific pharmacological and surgical therapies. Treatment options depend on the severity of symptoms, fistula location, the number and complexity of fistula tracts, and the presence of rectal complications. Internal fistulas, such as ileoileal or ileocecal fistulas, are mostly asymptomatic and do not require intervention. By contrast, perianal fistulas can be painful and abscesses may develop that require surgical drainage with or without seton placement, transient ileostomy, or in severe cases, proctectomy. This Review describes the epidemiology and pathology of fistulizing Crohn's disease. Particular focus is given to external and perianal fistulas, for which treatment options are well established. Available therapeutic options, including novel therapies, are discussed. Wherever possible, practical and evidence-based treatment regimens for Crohn's disease-associated fistulas are provided.

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Section: Glucocorticoidsmentioning

confidence: 95%

Diagnosis and management of fistulizing Crohn's disease

Nielsen

Rogler

Hahnloser

et al. 2009

Nat Rev Gastroenterol Hepatol

113

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“…Following 3 months of treatment, 75% of patients failed treatment entirely. Wheeler et al 19 evaluated the effectiveness of a standard regimen of aminosalicylates, antibiotics, and mercaptopurine for the treatment of 31 patients with enterovesicular fistulas; 42% had complete closure, 16% had partial closure, and 42% had no response to treatment. A long-term response was evident in only 39% of patients 21 found that cyclosporine A completely closed 50% and partially closed 25% of fistulas, yet only 4 of the patients had internal fistulas in the study.…”

Section: Discussionmentioning

confidence: 99%

Outcome of medical treatment of stricturing and penetrating Crohnʼs disease

Samimi

Flasar

Kavic

et al. 2010

Inflammatory Bowel Diseases

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The outcomes of medical treatment of stricturing or penetrating CD are poor, as 64% ultimately require surgery. Important factors that seem to be associated with either failed therapy include ileocolonic or colonic disease location. We report a high rate of IASC, especially in patients with penetrating disease and those treated with biologic therapy. This should be considered prior to attempted medical therapy.

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“…A 6-mercaptopurina mostrou, em nossos casos, ser uma droga eficaz em melhorar e/ou cicatrizar as fístulas em portadores da doença de Crohn, o que está de acordo com a literatura especializada (4,6,7,9) .…”

Section: Discussionunclassified

Estudo evolutivo de fístulas na doença de Crohn

Steinwurz

1999

Arq. Gastroenterol.

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RESUMOA doença de Crohn ainda é um desafio para os médicos e parece mostrar em todo o mundo uma tendência de aumento na sua incidência.Evidentemente que esta elevação nas estatísticas da moléstia, levou os gastroenterologistas a pesquisas mais apuradas no sentido de obter um melhor controle da doença e de suas complicações, já que sua causa e cura continuam desconhecidas.Uma das complicações mais inconvenientes para os portadores é a fístula, comunicação anômala de órgãos ou estruturas através de um pertuito anormal. Pode ser interna, entre órgãos intracavitários (interalças, enterovesical, enterovaginal, etc), ou se exteriorizar (fístula perianal, enterocutânea ou de parede abdominal, etc.) Além do aspecto fisiopatológico, de perda de nutrientes, dor, desconforto e infecção, a fístula pode causar constrangimentos quando com drenagem aparente abundante.No passado, a abordagem terapêutica para tais lesões era exclusivamente cirúrgica. Mais recentemente, com a experiência obtida, principalmente através do uso de drogas imunossupressoras, o tratamento clínico vem ganhando espaço. OBJETIVOAvaliar a evolução de fístulas em 16 pacientes portadores da doença de Crohn observados na década de 90 e submetidos a algum tipo de tratamento, clínico ou cirúrgico. CASUÍSTICADezesseis pacientes de nossa clínica privada, portadores de doença de Crohn e com a presença de fístulas comprovadas por exame clínico e/ou radiológico foram estudados quanto à evolução das mesmas.As fístulas foram relacionadas de acordo com o tipo, localização e quanto ao procedimento terapêutico adotado.O tratamento cirúrgico se fez através de fistulectomia ou ressecção de alças com fístulas. O tratamento clínico foi feito

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Medical therapy, not surgery, is the appropriate first line treatment for Crohn's enterovesical fistula

Cited by 30 publications

References 0 publications

Diagnosis and management of fistulizing Crohn's disease

Diagnosis and management of fistulizing Crohn's disease

Outcome of medical treatment of stricturing and penetrating Crohnʼs disease

Estudo evolutivo de fístulas na doença de Crohn

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