Infliximab treatment for anal fistula in patients with Crohn's disease.
BACKGROUND
Infliximab has played a central role in the treatment of luminal Crohn's disease (CD) due to its great usefulness. Although the seton placement has been widely used for the treatment of anal fistula in patients with CD, we have used infliximab for severe cases in which improvement was not achievable by the seton placement, or for patients in whom improvement of quality of life (QOL) could be expected.


METHODS
The anal region of 383 patients with CD was examined during the period from July 1985 to December 2005 and the presence of a lesion in the anal region was confirmed in 326 patients. Among them, the number of cases with fistula was highest (245), followed by those with skin tags (115), those with fissures (106), those with anal tumefaction and enlarged papillae (61), and those with anal stenosis (56). The seton placement was used for 93 patients with anal fistula; of these, 86 patients received the treatment for one year or more. During the treatment, infliximab was used for 19 patients and their pathology and progress were evaluated.


RESULTS
Infliximab was used for 11 severe cases in which improvement had not been achieved using the seton placement, and for 8 patients for improvement of their QOL. For evaluation, the patients who did not undergo additional treatment after infliximab administration were assigned to the good response group, those who underwent additional treatment other than surgical treatment to the intermediate response group and those who required surgical treatment to the poor response group. The good, intermediate and poor response groups included 8 (42.1%), 5 (26.3%) and 6 (31.6%) patients, respectively. A study of the relationship between the diagnostic indications of magnetic resonance imaging (MRI) and the course of disease showed that most of the patients with a localized inflammation of the anal fistula had better courses and most of the patients with diffuse inflammation had poor courses.


CONCLUSIONS
Approximately 70% of the patients required no surgical treatment. In addition, it was considered important to appropriately select patients for infliximab treatment. MRI was useful as a examination to be performed before infliximab administration because it enabled close examination of the localization of anal fistula and the range of inflammation.
Department of Surgery, Fukuoka University Chikushi Hospital, Chikusino-shi, Fukuoka 818-8502, Japan. daijiro@fukuoka-u.ac.jp
Daijiro
D
Higashi
Kitaro
K
Futami
Yuji
Y
Egawa
Kennji
K
Hirano
Takashige
T
Tomiyasu
Yukiko
Y
Ishibashi
Tamotsu
T
Simomura
Kaori
K
Nii
Hirosuke
H
Kuroki
Takafumi
T
Maekawa
Yoichiro
Y
Ono
Toshiyuki
T
Matsui
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000601:surgery; D000069285:Infliximab; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D012003:Rectal Fistula / Q000188:drug therapy* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab