Risk Factors and Outcomes of Management in Fistulizing Crohn's Disease

Abstract Background Crohn's disease (CD) patients often encounter perianal fistula formation, which can cause significant morbidity. Chronic transmural bowel inflammation in CD can lead to sinus tracts evolving into fistulas—abnormal connections between epithelial surfaces. Roughly 35-40% of patients develop fistulas, primarily perianal (54%), with internal fistulas posing diagnostic and therapeutic challenges. Fistulizing CD manifests severe symptoms, affecting quality of life and necessitating frequent hospitalizations and surgeries. Aim of the Work The aim of the work was to develop risk prediction and identify outcomes of management in fistulizing Crohn's disease. Patients and Methods This case-control study encompassed 90 Egyptian CD patients, divided into two groups: those with fistulas (external or internal) and those without. Patients were recruited from the Ain Shams outpatient clinic and Gastroenterology and Hepatology department. Clinical, radiological (CT or MR enterography), and colonoscopic assessments were performed. Risk factors, clinical characteristics, and treatment outcomes were examined. Results In the study, males were more prevalent in the fistula group; however, the difference wasn't statistically significant. Similarly, age and smoking differences were not statistically significant between the study groups. Entero-Entero fistulas were the most common, with Remicade and surgery being the predominant management strategy. NSAID intake significantly correlated with the fistula group. CDAI scores were higher in the fistula group but improved significantly with treatment in both groups. While colonoscopy findings varied minimally before and after treatment, cecum lesions showed significant increase post-treatment in the fistula group. No significant differences existed in outcomes according to management strategy within the fistula group. Conclusion In conclusion, this study underscores the heightened risk of NSAID intake in fistulizing Crohn's disease, emphasizes the effectiveness of CDAI scores in assessing disease activity and monitoring treatment outcomes, and highlights the importance of personalized management strategies for fistula patients. The significant increase in cecum lesions after treatment within the fistula group suggests the need for focused attention to this aspect. However, the study's limited scope on Egyptian CD patients calls for careful consideration when applying these findings to broader populations.