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.
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.
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.
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.
1Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France
2Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
3Department of Gastroenterology, Saint-Antoine Hospital, University Paris 6 Pierre and Marie Curie, Paris, France
4Department of Gastroenterology, Saint-Louis Hospital, University Paris 7 Denis Diderot, Paris, France
5Department of Gastroenterology, Gent Hospital, University of Gent, Gent, Belgium
6Department of Gastroenterology, Haut–Leveque Hospital, University of Bordeaux 2, Pessac, France
7Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
8Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France
9Department of Gastroenterology, Cote de Nacre Hospital, University of Caen, Caen, France
10Department of Gastroenterology, Rangueil University Hospital, University of Toulouse, Toulouse, France
11Department of Gastroenterology, Montpellier University Hospital, University of Montpellier, Montpellier, France
12Department of Gastroenterology, Edouard Herriot Hospital, University Lyon 1 Claude Bernard, Lyon, France
13These authors contributed equally to this work
Correspondence: Yoram Bouhnik, Department of Gastroenterology, IBD and Nutritional Support, Pôle des maladies de l’appareil digestif (PMAD), Beaujon University Hospital–APHP–Université Paris VII Denis Diderot, 100, Boulevard du général Leclerc, 92110 Clichy, France. E-mail: firstname.lastname@example.org
SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A975
Received 06 January 2014; accepted 12 May 2014
Guarantor of the article: Yoram Bouhnik, MD, PhD.
Specific author contributions: Conception and design of the study: Y.B., M.L., V.S., and A.A.; generation, collection, assembly, and analysis and/or interpretation of data: A.A., V.S., J.C., J.M.R., and Y.B.; drafting or revision of the manuscript: A.A., V.S., J.C., J.M.R., and Y.B.; approval of the final version of the manuscript: A.A., V.S., P.S., M.A., X.T., M.D.V., D.L., J.-F.C., V.A., J.M.R., J.M., M.V., B.F., J.C., and Y.B.
Financial support: None
Potential competing interests: A.A. has received consulting fees from Abbvie and lecture fees and travel accommodation from Abbvie and MSD. P.S. has received consulting fees from Abbvie, MSD and Biocodex. M.A. has received consulting fees from Abbvie, UCB Pharma, and MSD. D.L. has received lecture, consulting and advisory board membership fees from Abbvie and MSD. J.F.C. has received consulting, and lecture fees from AbbVie, MSD, and UCB Pharma, financial support for research from Abbvie and UCB Pharma, and is a shareholder in Intestinal Biotech Development. B.F. has received lecture fees from MSD. J.C. has received consulting fee from Abbvie. Y.B. has received advisory board membership fee from Abbvie, MSD and lecture fee from Abbvie, and is a shareholder in Inception IBD, San Diego, CA, USA.