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

Abstract

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.

Perianal Crohn Disease Is More Common in Children and Is Associated With Complicated Disease Course Despite Higher Utilization of Biologics

“…Perianal involvement has been shown in adults, and separately in children, to be associated with increased utilization of biologics and, on the other hands, increased hospitalizations (2,18–20) while there are controversial reports on surgery (18,20). A single-center retrospective Chinese study reported higher utilization of biologics in children compared to adults, but surgery risk was lower (21). Our study demonstrated worse disease outcomes in children including higher surgery rate.…”