Wing Yan Mak1, Oi Sze Mak2, Choon Kin Lee1,3, Whitney Tang1, Wai Keung Leung4, Marc T L Wong5, Alex Shun Fung Sze6, Michael Li7, Chi Man Leung8, Fu Hang Lo9, Belsy C Y Lam10, Kam Hon Chan11, Edwin Hok Shing Shan12, Steven Woon Choy Tsang13, Aric J Hui14, Wai Hung Chow15, Francis K L Chan1, Joseph J Y Sung1, Siew C Ng1. 1. Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong. 2. Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong. 3. Gastroenterology Unit, Department of Medicine, Hospital Pulau Pinang, Pulau Pinang, Malaysia. 4. Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong. 5. Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong. 6. Department of Medicine, Queen Elizabeth Hospital, Hong Kong. 7. Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong. 8. Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong. 9. Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong. 10. Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong. 11. Department of Medicine, North District Hospital, Hong Kong. 12. Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong. 13. Department of Medicine, Tseung Kwan O Hospital, Hong Kong. 14. Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong. 15. Department of Medicine, Yan Chai Hospital, Hong Kong.
Abstract
BACKGROUND: The presence of perianal fistulas in Crohn's disease [CD] denotes increased disease aggressiveness. We studied the epidemiology and clinical outcomes of perianal CD [PCD] using the Hong Kong territory-wide IBD Registry [HKIBDR]. METHODS: Consecutive patients with PCD were identified from the HKIBDR, and disease characteristics, treatments, and outcomes were analysed. The risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS: Among 981 patients with CD with 10530 patient-years of follow-up, 283 [28.8%] had perianal involvement, of which 120 [42.4%] were as first presentation. The mean age at diagnosis of PCD was 29.1 years, and 78.8% were male. The median follow-up duration was 106 months (interquartile range [IQR]: 65-161 months]. Perianal fistula [84.8%] and perianal abscess [52.7%] were the two commonest forms. Male, younger age at diagnosis of CD, and penetrating phenotypes were associated with development of PCD in multivariate analysis. Of 242 patients with fistulizing PCD, 70 [29.2%] required ≥5 courses of antibiotics, and 98 [40.5%] had ≥2 surgical procedures. Nine patients required defunctioning surgery and 4 required proctectomy. Eighty-four patients [34.7%] received biologics. Cumulative probabilities for use of biologics were 4.7%, 5.8%, and 8.6% at 12 months, 36 months, and 96 months, respectively, while the probabilities for surgery were 67.2%, 71.6%, and 77.7%, respectively. Five mortalities were recorded, including 2 cases of anal cancer, 2 CD-related complications, and one case of pneumonia. CONCLUSION: Over 40% of CD patients presented with perianal disease at diagnosis. Patients with PCD had poor outcome, with young age of onset, multiple antibiotic use, and repeated surgery.
BACKGROUND: The presence of perianal fistulas in Crohn's disease [CD] denotes increased disease aggressiveness. We studied the epidemiology and clinical outcomes of perianal CD [PCD] using the Hong Kong territory-wide IBD Registry [HKIBDR]. METHODS: Consecutive patients with PCD were identified from the HKIBDR, and disease characteristics, treatments, and outcomes were analysed. The risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS: Among 981 patients with CD with 10530 patient-years of follow-up, 283 [28.8%] had perianal involvement, of which 120 [42.4%] were as first presentation. The mean age at diagnosis of PCD was 29.1 years, and 78.8% were male. The median follow-up duration was 106 months (interquartile range [IQR]: 65-161 months]. Perianal fistula [84.8%] and perianal abscess [52.7%] were the two commonest forms. Male, younger age at diagnosis of CD, and penetrating phenotypes were associated with development of PCD in multivariate analysis. Of 242 patients with fistulizing PCD, 70 [29.2%] required ≥5 courses of antibiotics, and 98 [40.5%] had ≥2 surgical procedures. Nine patients required defunctioning surgery and 4 required proctectomy. Eighty-four patients [34.7%] received biologics. Cumulative probabilities for use of biologics were 4.7%, 5.8%, and 8.6% at 12 months, 36 months, and 96 months, respectively, while the probabilities for surgery were 67.2%, 71.6%, and 77.7%, respectively. Five mortalities were recorded, including 2 cases of anal cancer, 2 CD-related complications, and one case of pneumonia. CONCLUSION: Over 40% of CD patients presented with perianal disease at diagnosis. Patients with PCD had poor outcome, with young age of onset, multiple antibiotic use, and repeated surgery.
Authors: Gala M Godoy Brewer; George Salem; Muhammad A Afzal; Berkeley N Limketkai; Zadid Haq; Maryam Tajamal; Joanna Melia; Mark Lazarev; Florin M Selaru; Alyssa M Parian Journal: BMJ Open Gastroenterol Date: 2021-12
Authors: Abhinav Vasudevan; David H Bruining; Edward V Loftus; William Faubion; Eric C Ehman; Laura Raffals Journal: World J Gastroenterol Date: 2021-07-07 Impact factor: 5.742