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Intestinal Fistulas Medication

  • Author: David E Stein, MD; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 16, 2014
 

Medication Summary

As previously stated, it is not yet clear whether medications such as octreotide (a synthetic substitute of somatostatin that suppresses the release of many GI hormones) help to close fistulas. Although contradictory findings on the role of medication in fistula closure have been found, research has shown that octreotide decreases overall fistula output.[17] Immunosuppressive agents used in fistula therapy include azathioprine and infliximab.

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Somatostatin Analogs

Class Summary

These agents inhibit the release of serotonin and the secretion of many hormones involved in GI function.

Octreotide (Sandostatin)

 

Octreotide is an inhibitory hormone consisting of 2 peptides (14 amino acids and 28 amino acids in length) secreted by hypothalamus and delta cells of the stomach, intestines, and pancreas. It inhibits the release of growth hormone (GH) and thyroid-stimulating hormone (TSH) and suppresses the release of many GI hormones (gastrin, cholecystokinin, secretin, motilin, vasoactive intestinal polypeptide [VIP], glucose-dependent insulinotropic polypeptide [GIP]).

Octreotide results in decreased gastric emptying and reduces smooth muscle contractions and blood flow in the intestines. It is approved for use in treating acromegaly (since it blocks GH release) and symptoms related to carcinoid syndrome and VIPomas.

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Immunosuppressants

Class Summary

These agents inhibit the activity of key factors in the immune system.[24]

Azathioprine (Imuran, Azasan)

 

Azathioprine is a prodrug that is converted in the body to 6-mercaptopurine (6-MP). A member of a group of medicines called antimetabolites, azathioprine is a chemotherapy medication that inhibits the activity of the immune system, consequently reducing inflammation. Originally developed to treat certain forms of leukemia, the drug has been used to treat some conditions in which the immune system is overly active, such as Crohn disease. Clinical studies of azathioprine therapy have demonstrated a significant improvement in closure rates or improvement of the fistula site compared with placebo.

Infliximab (Remicade)

 

Infliximab is a monoclonal antibody with murine variable regions that specifically bind human tumor necrosis factor alpha (TNF-alpha), which has important role in promoting inflammation. By blocking the action of TNF-alpha, infliximab reduces signs and symptoms of inflammation. Clinical studies have demonstrated that infliximab significantly improved closure rates of fistulas in patients with Crohn disease and was as effective as maintenance therapy in reducing the number of relapses compared with previous medical treatment therapies.

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Contributor Information and Disclosures
Author

David E Stein, MD Chief, Division of Colorectal Surgery, Associate Professor, Department of Surgery, Director, Mini-Medical School Program, Drexel University College of Medicine; Chief, Division of Colorectal Surgery, Department of Surgery, Hahneman University Hospital; Consultant, Merck; Consultant, Ethicon Endo-Surgery; Consultant, Health Partners; Consultant, Cook Surgical

David E Stein, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, Association for Surgical Education, Pennsylvania Medical Society, Society for Surgery of the Alimentary Tract, Crohn's and Colitis Foundation of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Merck<br/>Serve(d) as a speaker or a member of a speakers bureau for: Merck.

Coauthor(s)

Asyia S Ahmad, MD Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Associate Program Director, Gastroenterology and Hepatology Fellowship Training Program, Drexel University College of Medicine

Asyia S Ahmad, MD is a member of the following medical societies: American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Radha V Menon, MD Resident Physician, Department of Internal Medicine, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Christopher K Chiu, MD Staff Physician, Department of General Surgery, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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