Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion

Singer, A; Gadepalli, Samir K.; Eder, Sally J.; Adler, Jeremy

doi:10.1542/peds.2015-2878

Cited by 19 publications

(18 citation statements)

References 20 publications

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“…In children, the prevalence of perianal disease in newly diagnosed Crohn's disease varies from 8 to 26%. 2,[7][8][9][10][11] The cumulative incidence of perianal Crohn's disease increases with disease duration. In a large multicenter prospective database cohort of over 6,600 pediatric Crohn's patients, perianal disease was reported in 21% while the estimated probability of developing perianal disease over time was 4, 9, 17, and 26% at 2 months, 1, 3,and 5 years after diagnosis, respectively.…”

Section: Epidemiologymentioning

confidence: 99%

Perianal Crohn's Disease in Children and Adolescents

Mutanen

Pakarinen

2020

Eur J Pediatr Surg

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The incidence of Crohn's disease is increasing worldwide. The clinical course of childhood onset Crohn's disease is particularly aggressive with characteristic disease localization in the ileocecal region and colon, often associated with perianal disease. Severe complications of perianal disease include recurrent perianal sepsis, chronic fistulae, fecal incontinence, and rectal strictures that impair quality of life and may require fecal diversion. Care of patients with perianal Crohn's disease requires a multidisciplinary approach with systematic clinical evaluation, endoscopic assessment, and imaging studies followed by combined medical and surgical management. In this review, we provide an update of the epidemiology, pathophysiology, diagnostics, and management of perianal Crohn's disease in children and adolescents.

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Section: Epidemiologymentioning

confidence: 99%

Perianal Crohn's Disease in Children and Adolescents

Mutanen

Pakarinen

2020

Eur J Pediatr Surg

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“…In the past decade, IFX was the only available biological agent for Chinese CD patients [24]. Due to its e cacy in treating complicated CD, IFX has been recommended widespreadly in cases of earlyonset or stulizing PCD as a top-down treatment strategy in recent years [4][5][6][7][8][9][10]. We found that POP has been increasing over time, which means there is a trend for POP patients to be diagnosed and treated more recently.…”

Section: Discussionmentioning

confidence: 83%

“…However, the successful development of various anti-tumour necrosis factor (TNF)-α agents (the rst biological agents for CD in the world) breaks this impasse. Due to their rapid e cacy in cases of complicated PD and luminal lesions, anti-TNF agents, including in iximab (IFX) and adalimumab, are recommended as the rst-line treatment for CD patients who have high-risk factors for poor outcomes, including PD, onset age < 40 years, and extensive small bowel involvement [4][5][6][7][8][9][10]. In China, IFX was the only available anti-TNF agent for CD from 2008 to 2018 and showed a more favourable perianal and luminal outcomes than traditional treatment in both children and adult PCD patients [11,12].…”

Section: Introductionmentioning

confidence: 99%

Perianal Disease Onset Age is Associated with Need for Abdominal Surgery in Perianal Crohn’s Disease: A Ten-year Observational Study in China

Wang

Wang³

et al. 2021

Preprint

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Background and aims: The significance of different ages of perianal disease (PD) onset in patients with perianal Crohn’s disease (PCD) remains unknown. We aimed to investigate the impact of paediatric-onset PD (POP, <18 years) and adult-onset PD (AOP, ≥18 years) on the Crohn’s disease (CD) course in a Chinese cohort.Methods: The medical records of the diagnosed PCD patients from 2008 to 2018 were reviewed retrospectively. The cumulative incidence of abdominal surgery was calculated using the Kaplan-Meier, and independent predictors of surgery were identified by logistic regression analysis.Results: Complex perianal fistulas (71.7% vs 50.0%, p=0.011) and infliximab (IFX) treatment (33.3% vs 22.0%, p=0.044) were more common among the POP patients (n=84). A younger PD onset age (15.1±2.9 vs 30.2±10.5 years, p<0.001) and shorter PCD diagnostic delay (12 vs 24 months, p =0.033) was seen in the POP cohort. AOP patients (n=209) had a higher rate of current smoking (12.9% vs 4.8%, p=0.040), stricturing behaviour (42.1% vs 27.4%, p=0.024) and abdominal surgery (21.1% vs 4.8%, p=0.001). The cumulative probability of abdominal surgery in AOP patients was higher than that in POP patients (p=0.007). In multivariable analysis, AOP (odds ratio [OR]: 2.915, 95% CI: 1.479-5.744, p=0.002) and stricturing behaviour (OR: 8.374, 95% CI: 1.055-66.488, p=0.044) were predictive factors for CD-related abdominal surgery in all PCD patients, complex perianal fistula was associated with the increased incidence of abdominal surgery in the AOP cohort (OR: 2.257, 95% CI: 1.041-4.891, p=0.039). The IFX administration significantly decreased the rate of abdominal surgery in AOP patients (r=-0.900, p=0.037). Conclusions: This Chinese cohort suggested that AOP indicate a later disease course and a higher risk of abdominal surgery than POP. Early diagnosis and positive IFX treatment could improve the prognosis of CD patients with AOP.

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“…14,15 They can cause pain, feculent drainage, fecal incontinence, and dyspareunia and are often associated with negative body image and depression. 15,37,38 Perianal fistulizing complications are difficult to treat; they often require invasive surgical procedures but still commonly reoccur. 5,39,40 Despite optimal medical and/or surgical therapy, there remains a substantial risk of requiring a permanent ostomy.…”

Section: Discussionmentioning

confidence: 99%

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

et al. 2020

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IMPORTANCE Perianal fistulizing complications (PFCs) develop in 15% to 30% of patients with Crohn disease (CD), are difficult to treat, worsen quality of life, increase cost of care, and commonly recur. Evidence-based strategies to prevent PFCs are lacking. OBJECTIVES To investigate the effectiveness of medical therapy for reducing risk of PFCs among young people with CD and to test the hypothesis that steroid-sparing therapy (SST) use would be associated with reduced risk of PFC development.

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Fistulizing Crohn’s Disease Presenting After Surgery on a Perianal Lesion

Cited by 19 publications

References 20 publications

Perianal Crohn's Disease in Children and Adolescents

Perianal Crohn's Disease in Children and Adolescents

Perianal Disease Onset Age is Associated with Need for Abdominal Surgery in Perianal Crohn’s Disease: A Ten-year Observational Study in China

Association Between Steroid-Sparing Therapy and the Risk of Perianal Fistulizing Complications Among Young Patients With Crohn Disease

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