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Several studies demonstrated that sulphasalazine and mesalazine are efficacious at high dose (3 g or more) for CD, but there is no evidence that these drugs are effective in fistula healing. Also corticosteroids have no proven efficacy in the treatment of fistulizing Crohn's disease. In most of the studies on steroid efficacy, patients were not randomized for fistulae [9]. A recent review [10] has associated in patients with fistulizing CD, the use of corticos-teroids with deleterious outcome, including an increased incidence of surgery in two large uncontrolled clinical trials [11,12]. In the European Cooperative Crohn's Disease study, three out of five CD-related deaths were in patients with a palpable abdominal mass receiving 6-methylprednisolone. Corticosteroids may mask clinical signs of an abdominal abscess with the attendant risk of delayed drainage [13,14]. Patients with enterovesical fistulae failed to heal when on steroids [15].

Fig. 3. Studies available on the effects of metronidazole on fistula healing or improvement

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