GASTROENTEROLOGY ARTICLE OF THE WEEK
DECEMBER 14, 2000
Lichtenstein, GR.
Treatment of Fistulizing Crohn’s
Disease. Gastroenterology
2000;119:1132-1147.
1. Evidence of
improvement in fistulizing Crohn’s disease has been demonstrated with which of the
following therapies (controlled and non-controlled studies)?
a. corticosteroids
b. ciprofloxacin alone
c. ciprofloxacin + metronidazole
d. aminosalicylates
e. metronidazole alone
f. 6-MP and azathioprine |
g. Methotrexate
h. cyclosporine A
i. tacrolimus
j. Mycophenolate mofetil
k. Infliximab
l. Thalidomide
|
True or False
2. The most common
type of enteroenteric fistula is the ileocolic, usually ileocecal or ileosigmoid in
location.
3. Retrograde cystograms
is the procedure of choice to diagnose the presence of an enterovesical fistula.
4. Pyelonephritis and
septicemia are common complications of enterovical fistulas, because of this, prompt
surgical correction of enterovesical fistulas is recommended.
5. Improvement in
Crohn’s disease in response to methotrexate therapy is usually evident in 4-8 weeks.
6. Cyclosporin A
must be administered intravenously in a continuous fashion to achieve clinical response in
fistulizing disease
7. A patient with
a symptomatic low (simple) perianal fistula should be treated with high dose
corticosteroids therapy prior to surgical approach.
8. In general,
enteroenteric fistula, when identified, should be corrected surgically.
9. Infliximab is
ineffective in the treatment of rectovaginal fistulas.
10. Gastrocolic
fistulas may present with diarrhea, weight loss, small bowel bacterial overgrowth and
evidence of malnutrition.
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