Clinical features of enteric and colo-duodenal fistula in patients with Crohn's disease.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 406 resection for management of CD. Usually, ECDF originates from diseased small and large intestines, not the duodenum. The common symptoms of ECDF are abdominal pain, diarrhea, and weight loss. However, these symptoms are difficult to distinguish from the symptoms of active CD, which makes early detection of ECDF difficult. The high intraluminal pressure found in the large intestine than in the duodenum in ECDF, colonic contents can flow back to the duodenum, but pylorus acts as a barrier to the reflux of the contents. Therefore, fecal vomiting is a pathognomonic symptom but very rare, occurring in only 0.5% to 2% of the cases. Further, ECDF is diagnosed by clinical manifestation, radiologic images, endoscopy, and intraoperative findings. Among them, contrast radiography is the most sensitive diagnostic tool, and barium enema is more susceptible than barium meal. Further, surgery is the most common ECDF treatment; no case has been reported to be cured with medical treatment, including with infliximab, which exhibits good effects on perianal fistulizing CD. In addition, surgery after failed biologic treatment increases postoperative complications in patients with CD. For these reasons, surgical treatment for ECDF is preferred even in the biologic era. However, since ECDF cases are rare, and surgery is not easy, the appropriate diagnostic approach and treatment for ECDF are controversial. Also, outcomes and long-term follow-up data of ECDF are not known. Therefore, we sought to investigate the clinical features of ECDF in patients with CD in Korea. We investigated all the CD patients with ECDF in a large tertiary hospital (Asan Medical Center, Seoul, Korea) between pISSN 1598-9100 • eISSN 2288-1956 https://doi.org/10.5217/ir.2022.00125 Intest Res 2023;21(3):406-410