Year 2022 / Volume 114 / Number 5
Original
Perianal Crohn’s disease: clinical implications, prognosis and use of resources

254-258

DOI: 10.17235/reed.2021.7918/2021

Elia Rosa Martínez Sánchez, Ana Solá Fernández, Domingo Pérez Palacios, Andrea Núñez Ortiz, María Dolores de la Cruz Ramírez, Eduardo Leo Carnerero, Claudio Trigo Salado, José Manuel Herrera Justiniano,

Abstract
Objective: to investigate the prevalence of perianal disease, the associated phenotypical factors, its influence on prognosis and its impact on the use of health resources for patients with Crohn’s disease. Methods: a unicentric retrospective observational study was performed with 430 patients with Crohn’s disease tracked through a monographical consultation of intestinal inflammatory disease. Demographic and phenotypical data of Crohn’s disease, pharmacological and surgical treatments, complementary tests carried out and hospital admissions were analyzed. A comparative study between those patients without perianal disease and those with perianal disease was performed, both in simple form and complex form. Results: the prevalence of perianal disease was 40.2 %, and fistulas and abscesses were the most frequent manifestations. These appearances were associated with an affected rectum and the existence of extra-intestinal manifestations. The patients with perianal disease most frequently required immuno-suppressant and biological treatment, but no further abdominal surgery. Amongst the patients with perianal disease, the need for biologics was more frequent for luminal disease (42.8 % vs 30.7 %). Furthermore, more explorations were needed, aimed at the study of perianal disease and recto-colonoscopies, although more magnetic resonance (MR)/computed tomography (CT) enterographies were not required. Conclusions: perianal disease has a high prevalence among patients with Crohn’s disease, especially when the rectum is affected. It is associated with a worse prognosis and more frequently requires biological treatments due to perianal and luminal evolution, especially in cases of complex perianal disease. This condition calls for more hospital admissions and complementary tests.
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References
1. Schwartz DA, Loftus E v., Tremaine WJ, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002; 122 (4), 875-80
2. Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal crohn’s disease in a population-based cohort. Diseases of the Colon and Rectum. 2012; 55 (7), 773-7
3. Zhao M, Lo BZS, Vester-Andersen MK, et al. A 10-year follow-up study of the natural history of perianal Crohn’s disease in a danish population-based inception cohort. Inflammatory Bowel Diseases. 2019; 25 (7), 1227-1236
4. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula‐in‐ano. British Journal of Surgery. 1976; 63 (1), 1-12
5. Bell SJ, Williams AB, Wiesel P, et al. The clinical course of fistulating Crohn’s disease. Alimentary Pharmacology and Therapeutics. 2003; 17 (9), 1145-51
6. Eglinton T, Reilly M, Chang C, et al. Ileal disease is associated with surgery for perianal disease in a population-based Crohn’s disease cohort. British Journal of Surgery. 2010; 97 (7), 1103-9
7. Michelassi F, Melis M, Rubin M, et al. Surgical treatment of anorectal complications in Crohn’s disease. Surgery. 2000; 128 (4), 597-603
8. Molendijk I, Nuij VJAA, et al. Disappointing durable remission rates in complex Crohn’s disease fistula. Inflammatory Bowel Diseases. 2014; 20 (11), 2022-8
9. Kasparek MS, Glatzle J, Temeltcheva T, et al. Long-term quality of life in patients with Crohn’s disease and perianal fistulas: Influence of fecal diversion. Diseases of the Colon and Rectum. 2007; 50 (12), 2067-74
10. Vollebregt PF, van Bodegraven AA, Markus-de Kwaadsteniet TML, et al. Impacts of perianal disease and faecal incontinence on quality of life and employment in 1092 patients with inflammatory bowel disease. Alimentary Pharmacology and Therapeutics. 2018; 47 (9), 1253-1260
11. Lennard-Jonnes JE. Classification of inflammatory bowel disease. Scand J Gastroenterol. 1989;24 Suppl. 170, 2-6.
12. MS Silverberg, J Satsangi, T Ahmad, et al. Toward an integrated clinical, molecular and serological classifcation of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19(Suppl A):5A-36A.
13. Tang Ly, Rawsthorne P, Bernstein CN, et al. Are perineal and luminal fistulas associated in Crohn’s disease? A population-based study. Clin Gastroenterol Hepatol. 2006; 4:1130–1134.
14. Shan CY, Zhang QQ, Xiao Y, et al. Incidence and risk factors of extraintestinal manifestations in children with inflammatory bowel disease. Zhonghua Er Ke Za Zhi 2019; 57 (9), 694-699
15. Young Hwangbo, Hyo Jong Kim, Ji Seon Park, et al. Sacroiliitis Is Common in Crohn’s Disease Patients with Perianal or Upper Gastrointestinal Involvement. Gut and Liver, 2010; 4 (3), 338-44.
16. S. Ardizzone, P. Sarzi Puttini, A. Cassinotti, et al. Extraintestinal manifestations of inflammatory bowel disease. Digestive and Liver Disease, 2008; 40 Suppl 2, S253–S259.
17. Rankin GB, Watts HD, Melnyk CS, et al. National Cooperative Crohn's Disease Study: extraintestinal manifestations and perianal complications. Gastroenterology. 1979 Oct;77(4 Pt 2):914-20.
18. Peyrin-Biroulet L, Panés J, Sandborn W, et al. Defining Disease Severity in Inflammatory Bowel Diseases: Current and Future Directions. Clinical Gastroenterology and Hepatology 2016;14:348–354
19. Lakatos P, Czegledi Z, Szamosi T, et al. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease. World Journal of Gastroenterology, 2009; 15 (28), 3504-10
20. Cosnes J, Cattan S, Blain A, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002; 8:244–250.
21. Sachar DB, Bodian CA, Goldstein ES, et al. Is perianal Crohn’s disease associated with intestinal fistulization? Am J Gastroenterol. 2005; 100:1547–1549.
22. Kotze P, Shen B, Lightner A, et al. Modern management of perianal fistulas in Crohn's disease: Future directions. Gut, 2018; 67 (6), 1181-1194.
23. Chaparro M 1 , Zanotti C , Burgueño P , et al. Health care costs of complex perianal fistula in Crohn's disease. Digestive diseases and sciences 2013; 58 (12), 3400-6
24. Rayen J, Currie T, Gearry RBet al. The long-term outcome of anti-TNF alpha therapy in perianal Crohn's disease. Tech Coloproctol. 2017; 21 (2), 119-124
25. Davidov Y, Ungar B, Bar-Yoseph H, et al. Association of Induction Infliximab Levels With Clinical Response in Perianal Crohn's Disease. J Crohns Colitis, 2017; 11 (5), 549-555
26. Chaparro M, Burgueno P, Vera I, et al. Epidemiological study of perianal fistulas in patients with Crohn’s disease. J Crohns Colitis. 2012;6 Suppl 1:P235.
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Martínez Sánchez E, Solá Fernández A, Pérez Palacios D, Núñez Ortiz A, de la Cruz Ramírez M, Leo Carnerero E, et all. Perianal Crohn’s disease: clinical implications, prognosis and use of resources. 7918/2021


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Publication history

Received: 23/02/2021

Accepted: 06/07/2021

Online First: 24/08/2021

Published: 06/05/2022

Article revision time: 132 days

Article Online First time: 182 days

Article editing time: 437 days


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