A modern multidisciplinary approach to the treatment of enterocutaneous fistulas in Crohn’s disease patients

Alfredo Papa, Gian Ludovico Rapaccini, Antonio Gasbarrini, Valerio Papa, Loris Riccardo Lopetuso, Laura Maria Minordi, Alessandra Di Veronica, Matteo Neri

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Enterocutaneous fistulas (ECFs) is a manifestation of penetrating Crohn’s disease (CD) that is challenging to treat and has considerable morbidity and mortality rates. Areas covered: This review aims to explore the practical and updated principles for the optimal treatment of ECFs in CD patients. Expert Opinion: Optimal ECF management requires a multidisciplinary approach. Treatment first includes fluid resuscitation and electrolyte rebalancing with control of sepsis by means of antibiotics and, when indicated, drainage of infected collections. Subsequent therapeutic steps include nutritional support, control of the fistula output and treatment of peristomal skin. Anti-TNF-α therapy seems to have limited utility only after sepsis is resolved and intestinal stenosis excluded. However, ECFs heal in only approximately one-third of cases without surgical intervention. Thus, correct surgical timing combined with adequate nutritional support, sepsis resolution and skin care is considered the appropriate preoperative setting.
Original languageEnglish
Pages (from-to)857-865
Number of pages9
JournalEXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
Volume14
DOIs
Publication statusPublished - 2020

Keywords

  • Crohn’s disease
  • Enterocutaneous fistula
  • anti-TNF-α
  • enteral nutrition
  • sepsis

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