mercaptopurine and Cutaneous-Fistula

Appropriate treatment of perianal fistulas in Crohn's disease (CD) involves accurate anatomic evaluation. EUS is an accepted imaging method for this purpose. The aim of the current study was to evaluate the clinical and endosonographic characteristics of perianal fistula in CD and to assess its impact on therapy.. All CD patients referred to the Sheba medical center from June 2004 to August 2008 for EUS examination of perianal fistulas were included. Perianal fistulas were diagnosed based on a clinical examination revealing at least one perianal cutaneous orifice. Demographic, clinical and therapeutic data was obtained. EUS was performed using an ultrasound scanner producing a 360° cross sectional image of the anal sphincters.. Fifty six patients were included in the study. Four patients were excluded from the final analysis: 3 because no fistula could be detected by EUS, and one due to inability to tolerate the examination. The mean CD duration was 10±9.16 years (range 1-37). Mean perianal disease duration was 5.3±6.5 (range 1-29) years. 27 patients had perianal involvement at presentation. Among the fistulas diagnosed, 13 were simple (25%) and 39 were (75%) complex. No correlation was found between CD duration or location, patients' age and gender or fistula location with fistula type or complexity. EUS results influenced patient management in 86% of the patients.. CD-associated perianal fistulas are mainly complex. EUS is a well tolerated and informative imaging modality, with significant impact on treatment.

Topics: Abscess; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anti-Infective Agents; Anti-Inflammatory Agents; Antibodies, Monoclonal; Anus Diseases; Azathioprine; Ciprofloxacin; Crohn Disease; Cutaneous Fistula; Endosonography; Female; Humans; Immunosuppressive Agents; Incidental Findings; Infliximab; Male; Mercaptopurine; Mesalamine; Metronidazole; Middle Aged; Rectal Fistula; Retrospective Studies; Tumor Necrosis Factor-alpha; Young Adult

Controlled trials have demonstrated the efficacy of methotrexate in the induction and maintenance of remission in luminal Crohn's disease; however, its effect on fistulizing disease is unknown.. To describe the response to methotrexate therapy in a series of patients with fistulizing Crohn's disease.. A retrospective chart review was conducted of all patients with Crohn's disease receiving methotrexate in one practice. The response of patients with fistulizing and luminal disease was assessed using clinical and laboratory criteria. Fistula response was categorized as either complete or partial closure.. Thirty-seven courses of methotrexate therapy were given to 33 patients with luminal and/or fistulizing Crohn's disease. In 16 patients with fistulas, four (25%) had complete closure, five (31%) had partial closure and all had failed or were intolerant to 6-mercaptopurine therapy. Overall, response to methotrexate was seen in 23 of 37 (62%) treatment courses in patients with luminal and/or fistulizing Crohn's disease. Two of the 33 patients (6%) had a significant adverse event.. In this case series, 56% of patients with Crohn's fistulas on methotrexate showed a complete or partial response to therapy. Further studies are needed to confirm the role of methotrexate alone, and in combination with other therapies, for the treatment of fistulizing Crohn's disease.

Topics: Abdominal Wall; Administration, Oral; Adolescent; Adult; Aged; Crohn Disease; Cutaneous Fistula; Cyclosporine; Female; Gastrointestinal Agents; Humans; Injections, Intramuscular; Intestinal Fistula; Male; Mercaptopurine; Middle Aged; Rectal Diseases; Retrospective Studies; Treatment Outcome; Urinary Bladder Diseases; Urinary Fistula; Vaginal Fistula