Anti-TNF-alpha (infliximab) used as induction treatment in case of active proctitis in a multistep strategy followed by definitive surgery of complex anal fistulas in Crohn's disease: a preliminary report.
OBJECTIVE
This study was designed to assess the healing rate of complex perianal fistulas in Crohn's disease after a multistep strategy, including induction treatment with Infliximab in case of active proctitis, followed by definitive surgery.


METHODS
From 2000 to 2003, all consecutive patients with complex fistulas and Crohn's disease underwent pretreatment with noncutting setons and, in case of severe recurrent fistulas or abscesses, a diverting stoma. Infliximab was added in cases of active proctitis. After definitive surgical treatment, patients were examined.


RESULTS
Seventeen patients were included (median age, 34 (range, 22-58) years). Seven patients were treated by surgery only, and in ten patients Infliximab was added. After a median follow-up of 19 (range, 8-40) months, fistula healing was observed in 17 patients (100 percent). One patient of the Infliximab group developed a recurrent fistula (10 percent) after 24 months, and in one patient (10 percent) soiling occurred. Two patients of the surgical group developed a recurrent fistula (29 percent) and soiling occurred in two patients (29 percent).


CONCLUSIONS
A multistep strategy followed by definitive surgery for the treatment of complex perianal fistulas in patients with Crohn's disease is a promising treatment modality. The preliminary results of this study suggest that Infliximab treatment has a beneficial additive effect in the multistep treatment followed by definitive surgery of complex anal fistulas and active proctitis in Crohn's disease.
van der Hagen
Stephan J
SJ
Department of Surgery, Academically Hospital of Maastricht, Maastricht, The Netherlands.
Baeten
Cor G
CG
Soeters
Peter B
PB
Russel
Maurice G V M
MG
Beets-Tan
Regina G
RG
van Gemert
Wim G
WG
D000038:Abscess / Q000209:etiology; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001004:Anus Diseases / Q000209:etiology; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000150:complications* / Q000188:drug therapy* / Q000209:etiology; D012003:Rectal Fistula / Q000188:drug therapy* / Q000601:surgery*; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha; D014945:Wound Healing
D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab