A modern multidisciplinary approach to the treatment of enterocutaneous fistulas in Crohn's disease patients.
Expert Rev Gastroenterol Hepatol
; 14(9): 857-865, 2020 Sep.
Article
in En
| MEDLINE
| ID: mdl-32673498
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Care Team
/
Crohn Disease
/
Intestinal Fistula
/
Cutaneous Fistula
Type of study:
Diagnostic_studies
/
Etiology_studies
Limits:
Humans
Language:
En
Journal:
Expert Rev Gastroenterol Hepatol
Journal subject:
GASTROENTEROLOGIA
Year:
2020
Document type:
Article
Affiliation country: