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News

The clinical course of fistulating Crohn's disease

Researchers from England find that the healing of Crohn's fistulas is usually achieved, however, morbidity is high and healing is slow.

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In this study, researchers determined the clinical characteristics, management and outcome of Crohn's fistulas from the time of first presentation.

The team's findings are published in the latest issue of Alimentary Pharmacology and Therapeutics.

The research team assessed 87 patients who had been treated for fistulas in the previous 6 years. They looked at disease demographics, fistula characteristics and treatment from first presentation to final follow-up.

The median age of patients was 35 years, and the median duration of Crohn's disease was 8 years at the beginning of the study.

Multiple fistulas were present in two-thirds of patients.
Alimentary Pharmacology and Therapeutics

The researchers found that disease was ileo-colonic or colonic in 85%, and 65% had rectal involvement.

In addition, a single fistula was present in one-third of patients, and multiple fistulas in two-thirds. The team determined that 65% of fistulas were perianal, and 80% were complex.

After median follow-up of 5.9 years, 68% of patients showed healing of all fistulas, 18% showed healing of some fistulas and 14% showed no healing of fistulas.

The team found that the fistula site did not influence healing.

Overall, perianal and recto-vaginal fistulas took a median of 2.6 years to heal.

However, half of the complex fistulas required a stoma, resection or proctectomy.

Dr Bell's team concluded, "Healing is usually achieved".

"However, morbidity is great and healing is slow".

"Proctectomy is required in one-fifth of patients, and perineal healing is often slow".

"Defining the perianal fistula anatomy as complex or simple determines the likelihood of healing and the type of surgical approach required".

Aliment Pharmacol Ther 2003; 17(9): 1145-51
12 May 2003

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