title: Palliative treatment of anal fistulas in Crohn's disease.
abstract: BACKGROUND
  Anal fistula in Crohn's disease is frequently an intractable condition. Methods of treatment are still debated because the results of various procedures are unsatisfactory. Available studies show that results can be improved using a combination of surgical and medical methods. Most patients undergo rather palliative than radical, curative procedures such as incision and drainage of abscesses and prolonged non-cutting seton placement. Surgery is combined today with biological therapy using infliximab, a murine-human chimeric monoclonal antibody against TNF-α or adalimumab a human monoclonal anti-TNF antibody to increase the healing process and in an attempt to prevent fistula recurrence.
  
  
  METHODS
  Medical records of 23 patients who were treated for anal fistulas in Crohn's disease between 2012 and 2014 were retrospectively evaluated.
  
  
  RESULTS
  There were 10 (43%) males and 13 females. The mean age was 39 years (range 29-60 years). Median duration of CD before present treatment was 6 years (range 1-15 years). Closure of all fistulas in 6 months was achieved in eight (35%) patients, whereas reduction of at least 50% from base line in the number of draining fistulas occurred in four (17%) patients.
  
  
  CONCLUSIONS
  Palliative and combined therapy for anal fistulas in Crohn's disease with surgery and infliximab or adalimumab therapy is an effective treatment for some patients.
authors: Department of General and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, Poznań, Poland.
authors: Jacek
authors: J
authors: Hermann
authors: Department of Gastroenterology, Human Nutrition, and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland.
authors: Piotr
authors: P
authors: Eder
authors: Department of General and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, Poznań, Poland.
authors: Tomasz
authors: T
authors: Banasiewicz
authors: Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poznań, Poland.
authors: Barbara
authors: B
authors: Kołodziejczak
authors: Department of Gastroenterology, Human Nutrition, and Internal Medicine, Poznań University of Medical Sciences, Poznań, Poland.
authors: Liliana
authors: L
authors: Łykowska-Szuber
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012003:Rectal Fistula / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn's disease; anal fistula; palliative treatment