%0 Journal Article
%T Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment F¨ªstulas enterocut¨¢neas en la enfermedad de Crohn: caracter¨ªsticas cl¨ªnicas y respuesta al tratamiento
%A Silvia G¨®mez-Senent
%A Manuel Barreiro-de-Acosta
%A Valle Garc¨ªa-S¨¢nchez
%J Revista Espa£¿ola de Enfermedades Digestivas
%D 2013
%I The Spanish Society of Digestive Pathology
%X Introduction: the low prevalence of enterocutaneous fistulas (ECF) in patients with Crohn's disease (CD) justifies the scarcity of studies that analyze the effect of medical treatment and the need for surgery in these patients. The objective of this study was to evaluate the clinical characteristics of patients with CD who have ECF and the response to different treatments. Materials and methods: patients with CD who presented ECF fistula between 1970 and 2009 in three tertiary centers in Spain were analyzed retrospectively for their clinical characteristics, response to treatment as well as the correlation between the response to biological therapies for ECF and perianal disease. The inflammatory activity of the disease was measured using the Harvey-Bradshaw index. The definitions of partial or complete response were based on the treating physician's judgment. Results: twenty six patients were included (18 women); in more than half of cases (67%), anti-TNF treatment improved fistula drainage. Postoperative fistulas responded better to anti-TNF treatment than did spontaneous fistulas (80 versus 57%). One hundred percent and 60% of spontaneous and postoperative fistulas closed after surgery, respectively. Conclusions: although the majority of patients required surgery as the ultimate treatment, anti-TNF drugs improved fistula output in an acceptable percentage of patients who were treated. Therefore, this may be a treatment strategy prior to surgery in a select group of patients. Introducci¨®n: la baja prevalencia de las f¨ªstulas enterocut¨¢neas (FEC) en los pacientes con enfermedad de Crohn (EC) justifica la escasez de estudios que analicen el efecto del tratamiento m¨¦dico y la necesidad de cirug¨ªa en estos pacientes. El objetivo del presente estudio ha sido evaluar las caracter¨ªsticas cl¨ªnicas de los pacientes con EC que presentan FEC y la repuesta a los distintos tratamientos. Material y m¨¦todos: se analizaron retrospectivamente los pacientes con EC que presentaron FEC desde 1970 a 2009 en tres centros terciarios de Espa a analizando las caracter¨ªsticas cl¨ªnicas de los pacientes, las respuestas a los tratamientos as¨ª como la correlaci¨®n entre la respuesta a terapias biol¨®gicas de la FEC y enfermedad perianal. La actividad inflamatoria de la enfermedad se midi¨® mediante el ¨ªndice de Harvey-Bradshaw. Las definiciones de respuesta parcial o completa se establecieron a juicio del m¨¦dico responsable. Resultados: se incluyeron 26 pacientes (18 mujeres), en m¨¢s de la mitad de los casos (67%) el tratamiento con anti-TNF mejor¨® el drenaje de la f¨ªstula. Las f¨ªstu
%K Enfermedad de Crohn
%K F¨ªstula enterocut¨¢nea
%K Tratamiento
%K Crohn's disease
%K Enterocutaneous fistula
%K Treatment
%U http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082013000100002