title: Long-term outcome of enterocutaneous fistula in patients with Crohn's disease treated with anti-TNF therapy: a cohort study from the GETAID.
abstract: OBJECTIVE
  Although anti-tumor necrosis factor (TNF) therapy is the treatment of choice for perianal fistulizing Crohn's disease (CD), the efficacy and safety of anti-TNF therapy in enterocutaneous fistula (ECF) remains unclear.
  
  
  METHODS
  Between January 2008 and December 2009, we retrospectively reviewed the outcomes of all CD patients with ECF (excluding perianal fistula) treated with anti-TNF therapy followed up in Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) centers. ECF closure and tolerance of anti-TNF therapy were studied using univariate and multivariate analyses.
  
  
  RESULTS
  Forty-eight patients (twenty-six women; median age 34.6 (interquartile range=25.0-45.5) years) were included in this study. The median follow-up period was 3.0 (2.0-6.6) years. The fistula was located in the small bowel (n=38), duodenum (n=1), and colon (n=9). The fistula has been developed in ileocolonic anastomosis in 17 (35%) cases. Sixteen patients (33%) had complex fistulas with multiple tracts and eleven patients (23%) had a high ECF output (if wearing an ostomy bag). Complete ECF closure was achieved in 16 (33%) patients, of whom eight relapsed during the follow-up period. In multivariate analysis, complete ECF closure was associated with the absence of multiple ECF tracts and associated stenosis. An abdominal abscess developed in 15 (31%) patients. ECF resection was needed in 26 (54%) patients. One patient died after surgery owing to abdominal sepsis.
  
  
  CONCLUSIONS
  In CD patients with ECF, anti-TNF therapy may be effective in up to one-third of patients, especially in the absence of stenosis and complex fistula. A careful selection of patients is mandatory to prevent treatment failure and improves the safety.
authors.affiliation: 1] Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France [2] These authors contributed equally to this work.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Amiot
authors.affiliation: 1] Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France [2] These authors contributed equally to this work.
authors.forename: Vida
authors.initials: V
authors.lastname: Setakhr
authors.affiliation: Department of Gastroenterology, Saint-Antoine Hospital, University Paris 6 Pierre and Marie Curie, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Department of Gastroenterology, Saint-Louis Hospital, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Allez
authors.affiliation: Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Treton
authors.affiliation: Department of Gastroenterology, Gent Hospital, University of Gent, Gent, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: De Vos
authors.affiliation: Department of Gastroenterology, Haut-Leveque Hospital, University of Bordeaux 2, Pessac, France.
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.affiliation: Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France.
authors.forename: Jean-Frederic
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France.
authors.forename: Vered
authors.initials: V
authors.lastname: Abitbol
authors.affiliation: Department of Gastroenterology, Cote de Nacre Hospital, University of Caen, Caen, France.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Reimund
authors.affiliation: Department of Gastroenterology, Rangueil University Hospital, University of Toulouse, Toulouse, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Moreau
authors.affiliation: Department of Gastroenterology, Montpellier University Hospital, University of Montpellier, Montpellier, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Veyrac
authors.affiliation: Department of Gastroenterology, Edouard Herriot Hospital, University Lyon 1 Claude Bernard, Lyon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Flourié
authors.affiliation: Department of Gastroenterology, Saint-Antoine Hospital, University Paris 6 Pierre and Marie Curie, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Department of Gastroenterology, Saint-Louis Hospital, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Lemann
authors.affiliation: Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D017577:Cutaneous Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D004378:Duodenal Diseases / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D000069285:Infliximab; D007412:Intestinal Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab