Infliximab in Pediatric Crohn Disease Patients with Enterovesicular Fistulas

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Enterovesicular fistulas (EVFs) in Crohn disease are relatively rare, having been first reported in the Netherlands in 1936 (1) not long after the initial description of regional enteritis by Crohn in 1932 (2). The incidence of EVFs among patients with Crohn disease ranges from 2% to 5% (3–6). The fistula arises typically from the ileum and less commonly from the colon (7) and clinically results in recurrent urinary tract infections, pneumaturia, or fecaluria.

Treatment typically includes surgery with resection of the fistulizing portion of the bowel. Medical treatment with corticosteroids and acetylsalicylic acid typically has not resulted in fistula closure. However, immunomodulators such as 6-mercaptopurine (6-MP) or azathioprine may be beneficial (8).

Infliximab (Remicade, Centocor, Malvern, PA), a chimeric mouse/human monoclonal antibody directed against tumor necrosis factor, frequently results in the healing of perianal fistulas (9). There has been 1 case report of an internal EVF that closed with infliximab (10). We describe the use of infliximab in 5 pediatric Crohn disease patients with documented EVFs and report on their respective outcomes.





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