Evolution and Prognosis of Digestif Fistulas in Crohn's Disease (CD) Other Than Ano-Perineal Manifestations (APM)

Abstract

Background and Objectives: Crohn's disease (CD) is a chronic inflammatory disease of the intestine. It can evaluate by the occurrence of intestinal complications in particular fistulas whose management can be medical or surgical. The objective of our work is to specify the evolutionary modalities, as well as the predictive factors of bad prognosis. Patients and Methods: this is a monocentric, descriptive and analytical retrospective study conducted in a hepato gastroenterology department including patients with fistulizing Crohn's disease, outside ano perineal fistulas from 1990 to 2023. Statistical analysis was performed using SPSS22.0 software. Results: Of a total of 960 patients, 38 had fistulizing CD. 65% of our patients were classified as A3 according to the Montreal classification, and 34% as A2. They were 24 women with a sex ratio of 1.71 F/H. The type of fistula was Greco-Greatic in 4 patients (10.5%), Greco-Colic in 5 patients (13%), Entero-Cutaneous in 12 patients (31.5%), Gastro-Colic in 3 patients (7.9%), Interdigestive and Entero-Cutaneous in 10 patients (26%), Interdigestive and Greco-Vesical in 2 patients. All our patients had benefited from a bi-antibiotic therapy, 33 had benefited from surgical resection. Postoperative treatments were based on therapeutic abstention in 5 patients (13.1%), immunosuppressive treatment in 18 patients (47%), anti TNF treatment in 7 patients (18%). The endoscopic recurrence rate 6 months after treatment was 32.5%. In univariate analysis, the factors influencing the evolution of fistulizing crohn's disease were the number of fistulas and age with p values lower than 0.05 (respectively 0.022 and 0.009). Conclusion: Digestive fistulas represent a complication during CD, which pose a problem of medical-surgical management and have an impact on the quality of life of the patients. Our study showed that age (p=0.022) and the number of fistulas (p=0.009) represent the factors influencing the natural history of fistulizing CD.