Abstract | OBJECTIVES: 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.
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Authors | Aurelien Amiot, Vida Setakhr, Philippe Seksik, Mathieu Allez, Xavier Treton, Martine De Vos, David Laharie, Jean-Frederic Colombel, Vered Abitbol, Jean Marie Reimund, Jacques Moreau, Michel Veyrac, Bernard Flourié, Jacques Cosnes, Marc Lemann, Yoram Bouhnik |
Journal | The American journal of gastroenterology
(Am J Gastroenterol)
Vol. 109
Issue 9
Pg. 1443-9
(Sep 2014)
ISSN: 1572-0241 [Electronic] United States |
PMID | 25091063
(Publication Type: Journal Article, Multicenter Study)
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Chemical References |
- Anti-Inflammatory Agents, Non-Steroidal
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Humanized
- Tumor Necrosis Factor-alpha
- Infliximab
- Adalimumab
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Topics |
- Adalimumab
- Adult
- Anastomosis, Surgical
(adverse effects)
- Anti-Inflammatory Agents, Non-Steroidal
(administration & dosage, therapeutic use)
- Antibodies, Monoclonal
(administration & dosage, therapeutic use)
- Antibodies, Monoclonal, Humanized
(administration & dosage, therapeutic use)
- Colon
(surgery)
- Colonic Diseases
(drug therapy, etiology, surgery)
- Crohn Disease
(complications, drug therapy, surgery)
- Cutaneous Fistula
(drug therapy, etiology, surgery)
- Duodenal Diseases
(drug therapy, etiology, surgery)
- Female
- Follow-Up Studies
- Humans
- Ileum
(surgery)
- Infliximab
- Intestinal Fistula
(drug therapy, etiology, surgery)
- Intestine, Small
- Male
- Middle Aged
- Retrospective Studies
- Time Factors
- Treatment Outcome
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
- Young Adult
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