医学
肠皮瘘
克罗恩病
瘘管
外科
四分位间距
单变量分析
内科学
胃肠病学
炎症性肠病
养生
多元分析
疾病
作者
Aurélien Amiot,V Setakhr,Philippe Seksik,Matthieu Allez,Xavier Tréton,Martine De Vos,David Laharie,Jean–Frédéric Colombel,Véred Abitbol,Jean Marie Reimund,Jacques Moreau,M. Veyrac,Bernard Flourié,Jacques Cosnes,Marc Lémann,Yoram Bouhnik
摘要
OBJECTIVES: Although anti-tumor necrosis factor (TNF) therapy is the treatment of choice for perianal fistulizing Crohn's disease (CD), the efficacy and safety of anti-TNF therapy in enterocutaneous fistula (ECF) remains unclear. METHODS: Between January 2008 and December 2009, we retrospectively reviewed the outcomes of all CD patients with ECF (excluding perianal fistula) treated with anti-TNF therapy followed up in Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) centers. ECF closure and tolerance of anti-TNF therapy were studied using univariate and multivariate analyses. RESULTS: Forty-eight patients (twenty-six women; median age 34.6 (interquartile range=25.0–45.5) years) were included in this study. The median follow-up period was 3.0 (2.0–6.6) years. The fistula was located in the small bowel (n=38), duodenum (n=1), and colon (n=9). The fistula has been developed in ileocolonic anastomosis in 17 (35%) cases. Sixteen patients (33%) had complex fistulas with multiple tracts and eleven patients (23%) had a high ECF output (if wearing an ostomy bag). Complete ECF closure was achieved in 16 (33%) patients, of whom eight relapsed during the follow-up period. In multivariate analysis, complete ECF closure was associated with the absence of multiple ECF tracts and associated stenosis. An abdominal abscess developed in 15 (31%) patients. ECF resection was needed in 26 (54%) patients. One patient died after surgery owing to abdominal sepsis. CONCLUSIONS: In CD patients with ECF, anti-TNF therapy may be effective in up to one-third of patients, especially in the absence of stenosis and complex fistula. A careful selection of patients is mandatory to prevent treatment failure and improves the safety.
科研通智能强力驱动
Strongly Powered by AbleSci AI