From the Guidelines
The most common enteric fistula occurring due to Crohn's disease is the perianal fistula, which develops in 20% of Crohn’s patients and recurs in approximately 30% of the cases, as reported in a global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease 1. This type of fistula imposes a significant burden on patients and is most frequent in colonic disease with rectal involvement.
Key Points
- Perianal fistulas are the most common manifestation of fistulising Crohn's disease, with a cumulative incidence that doubles 20 years after diagnosis 1.
- The risk of developing a fistula depends on disease location, being most frequent in colonic disease with rectal involvement 1.
- Management of enterocutaneous fistulas in Crohn's disease is complex and requires a multidisciplinary team, including a gastroenterologist, surgeon, and dietitian 1.
- Nutritional support is crucial in patients with fistulas, as malnutrition can increase the risk of complications and worsen outcomes 1.
- Early nutritional support, independently of the route of administration, can decrease the occurrence and severity of fistulas 1.
Management
- Medical therapy with immunomodulators or biologics may be used to control underlying inflammation, but surgical intervention may be necessary in cases of complications or failed medical management 1.
- Nutritional support, including enteral or parenteral nutrition, can help optimize the patient's nutritional status and improve outcomes 1.
- A dietetic optimization with adapted parenteral support can be proposed in cases of intestinal failure due to fistulas 1.
From the Research
Types of Fistulas in Crohn's Disease
- Perianal fistulas are the most frequent findings in fistulizing Crohn's disease, as stated in 2 and 3
- Enterocutaneous fistulas (ECFs) are rare but associated with considerable morbidity and mortality, as mentioned in 4, 2, and 5
Characteristics of Enterocutaneous Fistulas
- ECFs are a manifestation of penetrating Crohn's disease (CD) that is challenging to treat, as stated in 4
- They can occur between the GI tract and the abdominal cavity, adjacent organs, or the skin, as mentioned in 3
Management of Enterocutaneous Fistulas
- Optimal ECF management requires a multidisciplinary approach, including fluid resuscitation, electrolyte rebalancing, control of sepsis, and nutritional support, as stated in 4 and 5
- Treatment options include surgery, endoscopic procedures, antibiotics, biologic agents, and immunosuppressive drugs, as mentioned in 3 and 6
- A non-operative approach is generally accepted as the initial approach, especially in the acute/subacute setting, as stated in 6
Prevalence of Fistula Types
- The most prevalent type of fistula in Crohn's disease patients is the perianal fistula, which forms between the rectum and the skin near the anus, as mentioned in 3