Review article: medical therapy for fistulizing Crohn's disease
Article first published online: 16 OCT 2006
Alimentary Pharmacology & Therapeutics
Volume 24, Issue 9, pages 1283–1293, November 2006
How to Cite
BRESSLER, B. and SANDS, B. E. (2006), Review article: medical therapy for fistulizing Crohn's disease. Alimentary Pharmacology & Therapeutics, 24: 1283–1293. doi: 10.1111/j.1365-2036.2006.03126.x
- Issue published online: 16 OCT 2006
- Article first published online: 16 OCT 2006
- Publication data Submitted 29 June 2006 First decision 23 July 2006 Resubmitted 13 August 2006 Accepted 13 August 2006
Fistulae will develop in approximately one-third of patients with Crohn's disease. With an expected spontaneous healing rate of only 10%, fistulizing Crohn's disease requires a comprehensive strategy with a medical and possible surgical approach.
To summarize the current literature evaluating various medical options for treating patients with fistulizing Crohn's disease.
A literature review was conducted using PubMed (search terms: Crohn's disease and fistula) and manual search of references among the identified studies and relevant review papers to identify papers that present data on medical treatment of fistulizing Crohn's disease.
The first line of medical therapy remains antibiotics (metronidazole and ciprofloxacin). Mercaptopurine and azathioprine are medications that are effective in treating fistulizing Crohn's disease. The current gold standard of medical treatment to induce and maintain remission for fistulizing Crohn's disease is infliximab. Used as induction therapy, infliximab produced a 62% clinical response, and a complete closure rate of 46%. A maintenance therapy trial demonstrated at 54 weeks, 46% of patients receiving infliximab continued to respond to treatment, compared with 23% in the placebo group (P = 0.001).
Further research to find new therapies and to improve our existing medical treatment of fistulizing Crohn's disease is required.