title: Combining infliximab, anti-MAP and hyperbaric oxygen therapy for resistant fistulizing Crohn's disease.
abstract: BACKGROUND
  Fistulizing Crohn's disease (CD) presents a therapeutic challenge as fistulae are notoriously difficult to heal.Mycobacterium avium ss paratuberculosis(MAP) treatment in CD is gaining attention.
  
  
  OBJECTIVE
  We evaluated healing of CD fistula(e) using a novel combination therapy.
  
  
  METHODS
  Nine consecutive patients who failed to heal fistulae on conventional treatment including anti-TNF, were treated with at least three doses of infliximab, 18-30 courses of hyperbaric oxygen therapy and anti-MAP antibiotics comprising rifabutin, clarithromycin and clofazimine.
  
  
  RESULTS
  All patients achieved complete healing of fistulae by 6-28 weeks and follow-up for mean 18 months.
  
  
  CONCLUSIONS
  Combining infliximab, hyperbaric oxygen therapy and anti-MAP, seems to enable healing of recalcitrant fistulae and although a small case series, all nine patients achieved complete healing.
authors.affiliation: Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia; Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agrawal
authors.affiliation: Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia; Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Borody
authors.affiliation: Prince of Wales Hospital, 1st Floor, Edmund Blacket Building, Randwick NSW 2031, Australia; Prince of Wales Hospital, 1st Floor, Edmund Blacket Building, Randwick NSW 2031, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Turner
authors.affiliation: Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia; Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia.
authors.forename: Sharyn
authors.initials: S
authors.lastname: Leis
authors.affiliation: Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia; Centre for Digestive Diseases, Level 1/229 Great North Rd, Five Dock NSW 2046, Australia.
authors.forename: Jordana
authors.initials: J
authors.lastname: Campbell
keywords: Crohn's disease; Mycobacterium avium ss paratuberculosis; fistula; hyperbaric oxygen therapy; infliximab