Analysis of Fistula Cases in Crohn's Disease Patients from Brazilian National GEDIIB Registry

Background:
Inflammatory bowel diseases (IBD) manifest in various forms, significantly impacting patients’ quality of life. Crohn’s disease (CD) can lead to the development of perianal, enteroenteric, enterocutaneous, and enterovesical fistulas, posing challenges in patient management. This phenotype is considered a severity factor by many authors. This study focuses on the prevalence and management of fistulas in CD patients, with special attention to perianal fistulas, comparing national data with the literature.
Methods:
Data analysis of CD patients from Brazilian centers participating in the National GEDIIB Registry, focusing on the prevalence and types of fistulas, as well as the therapeutic approaches undertaken.
Results:
Out of a total of 4382 patients registered from August 2020 to August 2024, 2253 (51.4%) had CD, with fistula data available for 1846 patients, with a mean age of 43.2 (±16.2). The prevalence of perianal fistulas was 31.7% (n=586) among CD patients (previous studies indicate rates between 13% to 28%, and Schwartz’s study showed an incidence of 33% in 10 years and 50% in 20 years). Among CD patients with fistulas, 75.6% had anorectal fistulas, and about 54.4% of these were classified as complex. A combination of surgical and immunobiological treatment was adopted in 51.8% of cases. The most performed perianal surgeries were seton placement (31.9%) and fistulotomy (27.6%). Among patients with perianal fistulas, 78% (n=216) achieved complete fistula closure.
Conclusions:
The prevalence of fistulas in CD patients in Brazil highlights the need for integrated management, emphasizing the efficacy of combining surgical and immunobiological treatments. This study reinforces the importance of personalized therapeutic strategies for the effective management of fistulas in CD patients.