title: The clinical course of fistulating Crohn's disease.
abstract: OBJECTIVE
  To determine the clinical characteristics, management and outcome of Crohn's fistulas from the time of first presentation.
  
  
  METHODS
  Patients treated for fistulas 6 years previously were assessed for disease demographics, fistula characteristics and treatment from first presentation to final follow-up.
  
  
  RESULTS
  Eighty-seven patients with active Crohn's fistulas were evaluated. The median age was 35 years and the median duration of Crohn's disease was 8 years at study entry. Disease was ileo-colonic or colonic in 85%, and 65% had rectal involvement. A single fistula was present in one-third and multiple fistulas in two-thirds; 65% of fistulas were perianal; 80% of fistulas were complex. After a median follow-up from the last treatment 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 fistula site did not influence healing. Perianal and recto-vaginal fistulas took a median of 2.6 years to heal. Half of the complex fistulas required a stoma, resection or proctectomy.
  
  
  CONCLUSIONS
  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.
authors.affiliation: St Mark's Hospital, London, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Bell
authors.forename: A B
authors.initials: AB
authors.lastname: Williams
authors.forename: P
authors.initials: P
authors.lastname: Wiesel
authors.forename: K
authors.initials: K
authors.lastname: Wilkinson
authors.forename: R C G
authors.initials: RC
authors.lastname: Cohen
authors.forename: M A
authors.initials: MA
authors.lastname: Kamm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003108:Colonic Diseases / Q000150:complications* / Q000628:therapy; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000150:complications* / Q000628:therapy; D007412:Intestinal Fistula / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D014945:Wound Healing