Efficacy of Infliximab in the Treatment of Korean Patients with Crohn's Disease / 대한소화기학회지

BACKGROUND/AIMS: Infliximab has been proven to be effective for refractory luminal and fistulizing Crohn's disease (CD). We performed this study to demonstrate the efficacy of infliximab in Korean CD patients. METHODS: Medical records of 40 CD patients who had been treated with infliximab were reviewed retrospectively. RESULTS: Among 40 patients, 11 (27.5%) patients were treated for refractory luminal disease, 14 (35%) for fistulizing disease, and 15 (37.5%) for both types. Clinical response rate was higher in 26 patients with refractory luminal disease (Complete response (CR), 73.1%; Partial response (PR), 23.1%) than in 29 patients with fistulizing disease (CR, 41.4%; PR, 31%) (p=0.024). The clinical response rate tended to be higher in 28 patients with external fistulas (CR, 46.4%; PR, 32.2%) than 4 patients with internal fistulas (PR, 25%; NR, 75%) (p=0.064). Among patients with external fistulas, the response rate of 8 patients with enterocutaneous fistulas (CR, 50%; PR, 12.5%) was not different from 20 patients with perianal fistulas (CR, 45%; PR, 40%). Among 20 patients with perianal fistulas, the response rate of 6 patients with perianal fistulas without a history of operation (CR, 83.3%; PR, 0%) was higher than 14 patients with perianal fistulas resistant to previous surgical treatment (CR, 28.6%; PR, 57.1%) (p=0.044). As for adverse reaction, 7 patients experienced mild infusion reaction, and 2 patients developed serious infection. CONCLUSIONS: Infliximab is more effective for refractory luminal disease than for fistulizing disease. In addition, clinical responses to infliximab are different according to subtypes of fistulas. These findings should be considered for the proper use of infliximab.

Manejo conservador de la fístula quilosa postoperatoria con somatostatina / Treatment of chylous fistula with somatostatin: report of three cases

La fístula quilosa post quirúrgica es una complicación rara pero molesta en la cirugía torácica y abdominal, es en efecto difícil de manejar necesitando en un importante número de casos la reintervención. El abordaje inicial es conservador con dietas bajas en ácidos grasos de cadena media y/o nutrición parenteral total. Ultimamente se ha introducido el uso de la somatostatina, la que aparece como un tratamiento efectivo en el manejo de esta complicación, sugerido por algunos autores como terapia de primera línea .Se presentan tres casos en los que queda de manifiesto la efectividad del fármaco en la resolución de la fístula.

Role of octreotide in postoperative enterocutaneous fistula

Postoperative enterocutaneous fistulae, a serious complication of gastrointestinal surgery are associated with significant morbidity and mortality. Its management is based on nutritional support, control of sepsis, skin and wound care while waiting for fistula to close. Octreotide, a long acting somatostatin analogue, reduces gastrointestinal secretions and motility, hence reducing fistula output. Thirty one patients with postoperative enterocutaneous fistulae were administered octreotide subcutaneously and its effect on fistula output, till closing time were noted. There was a significant reduction in the fistula output, in 23[74%] patients fistula closed spontaneously in second week. Skin and wound were also easily managed. Although fistulahealing time was apparently reduced but, it was not possible to prove reduction in healing time convincingly, as to this end, controlled double blind trials are required. It is however, concluded that octreotide significantly reduces the morbidity by reducing - fistula output and assists in better skin and wound care

Pancreatico-pleural fistula: successful treatment with octreotide.

A patient with chronic pancreatitis who presented with massive pleural effusion due to pancreatico-pleural fistula is reported. Treatment with octreotide for three weeks healed the fistula and resolved the pleural effusion.

Octreotide in the management of entero-cutaneous fistulae

Efficacy of Octreotide [Somatostatin] in the conservative management of postoperative Enterocutaneous fistula was studied in seven patients with age ranging 1 to 70 years. Four out of seven fistulae closed within 21 days of starting the drug. One case, where fistula took over a month to close, responded well in reducing the output significantly within to days of starting therapy. The cases and the results are discussed. Favourable results following Octreotide therapy in this study need strengthening by further studies

Tratamento näo-cirúrgico das fístulas de ducto mamário / Non-surgical treatment of mamary duct fistula

Pacientes com fístula mamária foram tratadas de modo näo cruento pela injeçäo local de soluçäo a 1:1 de Lugol + polímero ácido metacresolsufônico a 36%, mediante cateterizaçäo do trajeto fistuloso. Foram estudadas 18 pacientes. Expöem-se a técnica utilizada, analisam-se os resultados baseado no seguimento e conclui-se pela validade deste novo método terapêutico