Infliximab Combined With Enteral Nutrition For Managing Crohn’s Disease Complicated With Fistula

Part 1 The value of Magnetic resonance imaging in the diagnosis of Crohn’s disease with fistulaAim:To investigate the value of magnetic resonance imaging in the diagnosis of Crohn’s disease with fistula.Methods: Twenty-three patients with Crohn’s disease complicated with fistula were analyzed from the First Affiliated Hospital of Wenzhou Medical University and the Second Affiliated Hospital of Wenzhou Medical University between October 2012 and October 2016.All patients underwent MRI,CT,endoscopy,and pathological examination.Result: Among 23 patients with CD complicated with fistula,22 cases were diagnosed as CD by MRI(positive rate: 95.7%),and fistulas were found in 19 cases(positive rate:82.6%),out of which 2 cases were of rectovulval fistula.In 21 cases(positive rate: 91.3%)CD was diagnosed by CT,out of which 8 cases(positive rate: 34.8%)of fistulas were detected.The detection rate of fistula by CT is much lower than that of MRI,and the difference was statistically significant(P<0.05).Additionally,CD based on colonoscopy was found in 19 cases,5 cases of which showed fistula orifices;Seventeen cases of small intestinal Crohn’s disease were diagnosed by double balloon endoscopy,but no fistula was found.MRI showed the wall thickness of the lesion to be 4-18 mm,and there was leaping multi-segmental distribution of the thickened intestinal wall.There were 8 cases of mesenteric lymph node enlargement.In the MRI examination,the following predominated: perianal fistulas in 15 cases,intestinal-abdominal wall fistula in 1 case,intestinal-abdominal fistula in 1 cases,rectovulval fistulas in 2 cases and abscess formation in 5 cases.Conclusion: MRI is valuable in the diagnosis of patients with CD complicated with fistula.Part 2 Infliximab combined with enteral nutrition for managing Crohn’s disease complicated with fistulaAim: This study was performed to evaluate the additional enteral nutrition(EN)in the efficacy of infliximab(IFX)compared with the conventional therapy in managing Crohn’s disease(CD)complicated with fistula.Methods: A total of 42 CD with fistula were randomly divided into infliximab treatment group(n=20)and conventional therapy group(n=22).We evaluated the laboratory indexes,Crohn’s disease activity index(CDAI),Crohn’s disease simplified endoscopic score(SES-CD),inflammatory bowel disease questionnaire of qualityof life(IBDQ)and healing of fistula in the two groups before treatment,at 14-week,and at 30-week,respectively.Results: In the IFX treatment group,the CDAI score,the SES-CD,erythrocyte sedimentation rate and C-reactive protein levels were significantly decreased during treatment compared with those before treatment(P<0.05).The body mass index and albumin levels were increased in both groups.And IBDQ was increased after treatment in the IFX treatment group(P<0.05),which was higher than that in the conventional therapy group(P<0.05).Moreover,in the IFX treatment group,fistula healing was found in 8 at the 14 th week and 18 at the 30 th week,respectively,which was greater than that in the conventional therapy group(P<0.05).Conclusion: Our study suggested that infliximab combined with EN is an effective treatment for CD patients complicated with fistula.