title: Outcomes of Medical and Surgical Therapy for Entero-urinary Fistulas in Crohn's Disease.
abstract: OBJECTIVE
  The aims of this study were to evaluate the frequency of entero-urinary fistulas in a cohort of Crohn's disease (CD) patients and to analyse the outcomes of medical and surgical therapy.
  
  
  METHODS
  This multicentre retrospective study included all CD patients with entero-urinary fistulas diagnosed by the presence of clinical symptoms and confirmed at surgery or by radiological or endoscopic techniques. We evaluated outcomes of medical and surgical therapy. We defined remission as absence of clinical symptoms with a radiological confirmation of fistula closure. Cox regression analysis was performed to evaluate factors predictive of achieving remission without need for surgery.
  
  
  RESULTS
  Of 6081 CD patients screened, 97 had entero-urinary fistulas (frequency 1.6%). Seventy-five percent of fistulas occurred in men. After a median follow-up of 91 months, 96% of patients were in sustained remission. Thirty-three patients (35%) received anti-tumour necrosis factor (TNF) therapy. Of these, 45% achieved sustained remission (median follow-up 35 months) without needing surgery. More than 80% of patients required surgery, which induced remission (median follow-up 101 months) in 99% of them. Only the use of anti-TNF agents was associated with an increased rate of remission without need for surgery (hazard ratio 0.23, 95% confidence interval 0.12-0.44; p < 0.001).
  
  
  CONCLUSIONS
  In this large cohort of CD patients, the frequency of entero-urinary fistulas was lower than previously described. More than 80% of patients required surgery, and in all but one of them surgery induced sustained remission. In a selected subgroup of patients, anti-TNF may induce long-term fistula remission and radiographic closure, making it possible to avoid surgery.
authors.affiliation: Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain carlos.taxonera@salud.madrid.org.
authors.forename: Carlos
authors.initials: C
authors.lastname: Taxonera
authors.affiliation: Department of Gastroenterology, Hospital Clínico de Santiago, Santiago de Compostela, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreiro-de-Acosta
authors.affiliation: Department of Gastroenterology, Hospital La Fe, Valencia, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bastida
authors.affiliation: Department of Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Martinez-Gonzalez
authors.affiliation: Department of Gastroenterology, Hospital de Cruces, Bilbao, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Merino
authors.affiliation: Department of Gastroenterology, Hospital Reina Sofía and IMIBIC, Universidad de Córdoba, Córdoba, Spain.
authors.forename: Valle
authors.initials: V
authors.lastname: García-Sánchez
authors.affiliation: Department of Gastroenterology, Hospital de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: Javier P
authors.initials: JP
authors.lastname: Gisbert
authors.affiliation: Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Marín-Jiménez
authors.affiliation: Department of Gastroenterology, Hospital Alcorcón, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: López-Serrano
authors.affiliation: Department of Gastroenterology, Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Gómez-García
authors.affiliation: Department of Gastroenterology, Hospital Reina Sofía and IMIBIC, Universidad de Córdoba, Córdoba, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Iglesias
authors.affiliation: Department of Gastroenterology, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Sanroman
authors.affiliation: Department of Gastroenterology, Hospital de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
authors.forename: María
authors.initials: M
authors.lastname: Chaparro
authors.affiliation: Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Saro
authors.affiliation: Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bermejo
authors.affiliation: Department of Gastroenterology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Pérez-Carazo
authors.affiliation: Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Plaza
authors.affiliation: Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Olivares
authors.affiliation: Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Alba
authors.affiliation: Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
authors.forename: Juan L
authors.initials: JL
authors.lastname: Mendoza
authors.affiliation: Inflammatory Bowel Disease Unit, Hospital Moncloa, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Fernández-Blanco
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D014548:Urinary Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000069285:Infliximab; D015122:Mercaptopurine; D000068879:Adalimumab
keywords: Crohn’s disease; adalimumab; anti-TNF; entero-urinary fistula; enterovesical fistula; infliximab