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P650. Entero-urinary fistulas in Crohn's disease: prevalence and clinical manifestations

C. Taxonera1, I. Fernández-Blanco2, M. Barreiro-de Acosta3, G. Bastida4, A. López-San Román5, O. Merino6, V. García-Sánchez7, J.P. Gisbert8, I. Marín-Jiménez9, P. López-Serrano10, E. Iglesias7, J. Martínez-González5, M. Chaparro8, F. Bermejo11, C. Saro12, L. Pérez-Carazo9, R. Plaza13, D. Olivares1, M. Cañas1, J.L. Mendoza1, 1H Clinico San Carlos, IBD Unit, IdiSSC, Madrid, Spain, 2Hospital Moncloa, Madrid, Spain, 3H Clínico de Santiago, Santiago de Compostela, Spain, 4H La Fe, Valencia, Spain, 5H Ramón y Cajal, Madrid, Spain, 6H Cruces, Barakaldo, Spain, 7H Reina Sofía, Córdoba, Spain, 8H La Princesa, CIBERehd, Madrid, Spain, 9H Gregorio Marañón, Madrid, Spain, 10H Alcorcón, Madrid, Spain, 11H Fuenlabrada, Madrid, Spain, 12H de Cabueñes, Gijón, Spain, 13H Infanta Leonor, Madrid, Spain

Background

The prevalence of entero-urinary fistulas (EUFs) in Crohn's disease (CD) is not well known. The success of medical treatment for EUF has so far been modest, and surgery is the standard treatment. The aim of the study was to investigate the frequency, demographics and clinical manifestations of EUFs.

Methods

In this multicentre observational study, a retrospective search in prospectively maintained databases was performed for CD patients with EUF. Patient demographics, sites of the EUFs and presenting symptoms were assessed. EUFs were diagnosed by the presence of clinical symptoms confirmed at surgery or by radiological or endoscopic techniques. We defined remission as the absence of clinical symptoms with a radiological confirmation of fistula closure. Data were centrally monitored.

Results

Ninety-seven patients with EUF were identified from among 6081 CD patients from 13 centres. The frequency of EUF was 1.6% (95% CI 1.3–1.9). EUFs were equally frequent in centres up to 350 CD patients (1.4%) compared with larger centres (1.7%, p = 0.63). Prevalence of EUF was significantly higher in males (2.3%) than in females (0.9%, p < 0.001).

Seventy-three out of 97 (75%) patients were male. Mean (SD) age at diagnosis of EUF was 32 (14) years and median disease duration was 22 months (IQR 6–90). CD Montreal phenotype before EUF diagnosis was distributed as following: A1 (9%), A2 (76%), A3 (15%); L1 (42%), L2 (13%), L3 (42%), L1+L4 (2%); B1 (45%), B2 (3%), B3 (52%); p (21%). Fistulas originated from the ileum (64%), colon (23%), rectum (7%), jejunum (2%) and multiple sites (3%). Urinary tract sites were bladder (93%), ureter (6%) and urethra (1%). Thirty-eight patients (39%) showed another type of fistula excluding perianal (entero-enteric, entero-cutaneous, peristomal, blind or entero-vaginal). Patients presented pneumaturia (34%), fecaluria (31%), dysuria (30%), hematuria (15%) and recurrent urinary tract infections (73%).

At the last follow-up visit, 93 (96%) patients were in sustained remission. A total of 79 patients (81%) required surgery, and 74 (94%) were in sustained remission (median 101 months, IQR 58–150).

Conclusion

In a large cohort the prevalence of EUF in CD was consistently 1.6%. EUF occurred more often in men. EUFs most commonly originated from the ileum, and almost all were enterovesical. EUFs were frequently associated with other type of internal or external fistulas. Surgery induced sustained remission in the majority of patients.