Does prednisone utilization make the healing of fistula with medication more difficult or less likely?

[David]

Catherine recently asked our panel of experts:

Does prednisone utilization make the healing of fistula with other medication more difficult or less likely?

Dr. Andrew Tinsley, M.D. of the Penn State Hershey Inflammatory Bowel Disease Center took time out of his busy schedule to answer this question. A little about Dr. Tinsley:

Dr. Andrew Tinsley was born and raised in England but attended medical school at the University of Vermont in Burlington. Following graduation from medical school, he completed internship and Residency in Internal Medicine at Massachusetts General Hospital / Harvard Medical School. He then entered a Gastroenterology Fellowship at Mount Sinai School of Medicine, NYC. While there, he was mentored there by Dr. Bruce Sands and received his IBD training from the likes of Asher Kornbluth, David Sachar, Thomas Ullman and John Fred Colombel. He was the Chief GI Fellow at Sinai in 2011-2012 and, while in New York, he also received a Masters in Biostatistics from Columbia University.

Currently, Dr. Tinsley is an Assistant Professor of Medicine at Penn State Hershey and Associate Director of the IBD Center there. In addition to seeing patients at the IBD Center, he carries out clinical research related to Crohn's disease and ulcerative colitis. His focus is on optimizing current treatment strategies and improving patient outcomes. Dr. Tinsley is a member of the CCFA and is fortunate to be part of a their IBD quality of care committee.

In regards to the question, Dr. Tinsley stated:

Unlike biologic (infliximab) therapy, or possibly azathioprine and mercaptopurine medications, prednisone use has not been shown to heal internal or perianal fistulas. As such, patients should not be placed on these medications for the purpose of fistula healing. In my opinion, the addition of prednisone to azathioprine, mercaptopurine or biologic therapy to treat a Crohn’s fistula would not be an effective strategy and may lead to various side-effects and complications.

Thank you to Dr. Tinsley for his time and expertise!

 

[David]

I see a LOT of people on this forum put on prednisone to treat fistulae. I hope that people start to link such stories to this thread.

 

[fissure2]

what about a fissure?