mercaptopurine and Urinary-Fistula

The aims of this study were to evaluate the frequency of entero-urinary fistulas in a cohort of Crohn's disease (CD) patients and to analyse the outcomes of medical and surgical therapy.. This multicentre retrospective study included all CD patients with entero-urinary fistulas diagnosed by the presence of clinical symptoms and confirmed at surgery or by radiological or endoscopic techniques. We evaluated outcomes of medical and surgical therapy. We defined remission as absence of clinical symptoms with a radiological confirmation of fistula closure. Cox regression analysis was performed to evaluate factors predictive of achieving remission without need for surgery.. Of 6081 CD patients screened, 97 had entero-urinary fistulas (frequency 1.6%). Seventy-five percent of fistulas occurred in men. After a median follow-up of 91 months, 96% of patients were in sustained remission. Thirty-three patients (35%) received anti-tumour necrosis factor (TNF) therapy. Of these, 45% achieved sustained remission (median follow-up 35 months) without needing surgery. More than 80% of patients required surgery, which induced remission (median follow-up 101 months) in 99% of them. Only the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12-0.44; p < 0.001).. In this large cohort of CD patients, the frequency of entero-urinary fistulas was lower than previously described. More than 80% of patients required surgery, and in all but one of them surgery induced sustained remission. In a selected subgroup of patients, anti-TNF may induce long-term fistula remission and radiographic closure, making it possible to avoid surgery.

Topics: Adalimumab; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Inflammatory Agents; Case-Control Studies; Combined Modality Therapy; Crohn Disease; Female; Follow-Up Studies; Humans; Infliximab; Intestinal Fistula; Male; Mercaptopurine; Middle Aged; Proportional Hazards Models; Remission Induction; Retrospective Studies; Treatment Outcome; Ureteral Diseases; Urinary Bladder Diseases; Urinary Fistula; 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

Topics: Adrenal Cortex Hormones; Azathioprine; Crohn Disease; Digestive System Fistula; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Mercaptopurine; Urinary Fistula; Wound Healing