Risk Stratification and Outcomes of Management in Egyptian Patients with Fistulizing Crohn's Disease

Background: Crohn’s disease (CD) is a chronic, relapsing inflammatory condition of uncertain origin that can affect any segment of the gastrointestinal tract in a transmural pattern, often resulting in complications such as fistulae or perforation. Although its prevalence appears to be rising in Egypt, precise epidemiological figures are lacking. The present study was designed to identify risk factors associated with fistulizing CD and to examine treatment outcomes in affected Egyptian patients.Methods: The present retrospective–prospective cohort study comprised 90 Egyptian individuals with Crohn’s disease, divided into a fistulizing group (n = 45) and a non-fistulizing group (n = 45). The clinical features, risk factors, and treatment outcomes were evaluated. The clinical, radiographic, and colonoscopic examinations were also performed and assessed before and after treatment.Results: Male sex and smoking were more prevalent but not significant among cases with fistulizing CD. Enteroenteric fistulas were the most common subtype, while infliximab therapy and surgical intervention were the most frequent treatment strategies. The use of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly higher in the fistula group. Both groups showed significant improvement following treatment, as indicated by the simplified endoscopic activity score for Crohn’s disease (SES-CD) and the Crohn’s Disease Activity Index (CDAI), with the fistula group demonstrating a more substantial response.In conclusion, this study identifies NSAID use as a significant risk factor for the development of fistulizing Crohn’s disease. It reinforces the clinical utility of CDAI scores in evaluating disease activity and monitoring treatment outcomes.