title: Genital fistulas in female Crohn's disease patients.: clinical characteristics and response to therapy.
abstract: BACKGROUND
  Genital fistulas (GF) can arise in the course of Crohn's disease (CD), are difficult to manage and determine a significant alteration of the quality of life.
  
  
  OBJECTIVE
  To review the joint experience of the Inflammatory Bowel Disease Units in six University Hospitals in the management of GF in Crohn's disease on female patients.
  
  
  RESULTS
  A total of 47 patients with GF were identified, affecting 3.8% of women with CD treated in our centers. A 47.5% of patients were smokers. The median of time from the diagnosis of CD reached 102 months. According to anatomical type, GF were classified as rectovaginal (74.5%), anovaginal/anovulvar (21.3%) and enterovaginal (4.3%). Main symptoms were vaginal discharge of fecal material (55.3%), vaginal passage of gas (40.4%), or both. Fistulas were treated with antibiotics in 59.6% of patients, without any lasting success. Thiopurines were used in 80.9% of cases, with 13.2% of complete and 23.7% of partial responses. Anti TNF-alpha therapy was applied in 63.8%, with a 16.7% of complete and a 30% of partial responses (all responding patients received infliximab). Surgery was indicated in 38.3% of patients, with a 22% of complete responses after a first operation and 38.8% after reintervention. In all, definitive closure after one or more of these therapies was achieved in only 31.9% of cases.
  
  
  CONCLUSIONS
  Genital fistulas are a significant problem in female Crohn's disease patients. Therapy is not well defined and only partially effective (one in three cases). Surgical therapy stands out as the most effective treatment.
authors.affiliation: Digestive Department Ramón y Cajal Hospital, Spain. gemadelapoza@gmail.com
authors.forename: Gema
authors.initials: G
authors.lastname: de la Poza
authors.forename: Antonio
authors.initials: A
authors.lastname: López-Sanroman
authors.forename: Carlos
authors.initials: C
authors.lastname: Taxonera
authors.forename: Ignacio
authors.initials: I
authors.lastname: Marín-Jimenez
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
authors.forename: Verónica
authors.initials: V
authors.lastname: Opio
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D005402:Fistula / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008795:Metronidazole / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012006:Rectovaginal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012907:Smoking; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014624:Vaginal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014845:Vulvar Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D011687:Purines; D014409:Tumor Necrosis Factor-alpha; D008795:Metronidazole; D002939:Ciprofloxacin; D000069285:Infliximab; D000068879:Adalimumab