scholarly journals Perianal disease onset age is associated with distinct disease features and need for intestinal resection in perianal Crohn’s disease: a ten-year hospital-based observational study in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haichao Wang ◽  
Yaling Wu ◽  
Chen Ye ◽  
Zhanju Liu ◽  
Xiaolei Wang
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Multivariable Analysis ◽  
Intestinal Resection ◽  
Perianal Disease ◽  
Cumulative Probability ◽  
Onset Age ◽  
Perianal Crohn’S Disease ◽  
The Impact ◽  
Perianal Crohn's Disease

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) and adult-onset PD (AOP) on the Crohn’s disease (CD) course in a Chinese cohort. Methods The medical records of diagnosed PCD patients from 2008 to 2018 were reviewed retrospectively. The cumulative incidence and predictors of intestinal resection were calculated using the Kaplan–Meier and 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 (age < 18 years old, 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 found in the POP cohort. AOP patients (age ≥ 18 years old, 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 intestinal resection (21.1% vs 4.8%, p = 0.001). The cumulative probability of intestinal resection in AOP patients was higher than that in POP patients (p = 0.007). In multivariable analysis, AOP (OR: 4.939, 95% CI 1.538–15.855, p = 0.007), stricturing behaviour (OR: 1.810, 95% CI 1.008–3.251, p = 0.047) and rectal inflammation (OR: 3.166, 95% CI 1.119–8.959, p = 0.030) were predictive factors for CD-related intestinal resection in all PCD patients. AOP patients with complex perianal fistula (OR: 2.257, 95% CI 1.041–4.891, p = 0.039) and POP patients with rectal inflammation (OR: 3.166, 95% CI 1.119–8.959, p = 0.030) were more likely to suffer intestinal resection. The IFX administration significantly decreased the rate of intestinal resection in AOP patients (r = − 0.900, p = 0.037). Conclusions The AOP patients have more complicated luminal disease and higher rate of intestinal resection than COP patients. The perianal diseases onset-age can provide clinical treatment guidance for individual management of CD patients.

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

2021 ◽  
Author(s):  
Haichao Wang ◽  
Yaling Wu ◽  
Chen Ye ◽  
Zhanju Liu ◽  
Xiaolei Wang
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Perianal Disease ◽  
Cumulative Probability ◽  
Onset Age ◽  
Perianal Crohn’S Disease ◽  
Chinese Cohort ◽  
The Impact ◽  
Perianal Crohn's Disease

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.

scholarly journals P593 Ustekinumab for the treatment of perianal Crohn’s disease. A real-world experience in a Spanish hospital

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S542-S542
Author(s):  
M Algara San Nicolas ◽  
A Masedo Gonzalez ◽  
G J Gomez Gomez ◽  
C Yela San Bernardino ◽  
B Casis Herce ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Real World ◽  
Treatment Success ◽  
Multivariable Analysis ◽  
Intestinal Resection ◽  
Perianal Crohn’S Disease ◽  
Fistula Treatment ◽  
Perianal Crohn's Disease

Abstract Background Perianal Crohn’s disease (pCD) is difficult to treat. Although anti-TNF, are the medical mainstay in fistula treatment, many patients become refractory. Recent data suggested that ustekinumab (UST) might be effective in pCD. This study aims to assess the effectiveness of UST in refractory pCD in the real-world practice. Methods This is a retrospective cohort of patients with pCD treated with UST in our IBD Unit between march 2015 and october 2020. We analyze demographics, disease charactersistics, surgical for pCD and prior exposure including inmunomodulators and biologic agents. The success of UST was defined on the physician judgment (improvement or absence of drainage). In patients with inactive pCD we analyzed rate of relapse. To analyze predictive factors of treatment success we performed a univariate and multivariable analysis. Results Fifty three patients were included (54.72 % female). Twenty four of them were smokers. The median age was 54 years (45–62). The mean duration of CD was 19 years and 50.94% had an intestinal resection. Fifty one patients (96,22%) had been treated with at least 1 anti-TNF and 38 (71.7%) with at least 2 anti-TNF. Sixteen had failed to vedolizumab. The median follow-up was 26 months (15–36). Twenty two (22/53) had active pCD. Eleven (50%) had intensified UST out of technical sheet (8 with 90 mg sc every 4 to 6 w, and 3 had 130 mg iv every 4 w). Fifteen patients (68.18 %; p&lt;0.001) had clinical improvement after started UST, 10/22 (45.45%; p &lt;0.001) radiological improvement and no one of them require other treatment (p &lt; 0.006). In multivariable analysis, no factors were associated with clinical or radiological improvement. Two of 32 patients (6.45%) with inactive pCD relapsed during the follow-up. Eleven patients (20.75%) discontinued UST: 6/53 (11.3%) due to adverse events (infections and arthralgia), 4/53 (7,54) patient′s choice or physician judment. One patient who had been treated with four biologics before UST developed a pleomorphic cutaneous sarcoma Conclusion Ustekinumab might by an effective treatment in refractory pCD. More studies are needed to confirm our data

Perianal Crohn's Disease in Children and Adolescents

2020 ◽  
Vol 30 (05) ◽  
pp. 395-400
Author(s):  
Annika Mutanen ◽  
Mikko P. Pakarinen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Children And Adolescents ◽  
Perianal Disease ◽  
Ileocecal Region ◽  
Perianal Crohn’S Disease ◽  
Perianal Sepsis ◽  
Endoscopic Assessment ◽  
Perianal Crohn's Disease

AbstractThe 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.

scholarly journals Management of Complex Anorectal and Perianal Crohn's Disease

2019 ◽  
Vol 32 (04) ◽  
pp. 255-260 ◽  
Author(s):  
Vladimir Bolshinsky ◽  
James Church
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Crohn's Disease ◽  
Perianal Disease ◽  
Perianal Area ◽  
Perianal Crohn’S Disease ◽  
Fecal Urgency ◽  
Perianal Crohn's Disease

AbstractPerianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues themselves. This key distinction should drive the investigation and management of anal and perianal symptoms in patients with Crohn's disease. In this review, the evaluation and management of the various manifestations of Crohn's disease in the perineum and perianal tissues will be described.

Mo1252 The Impact of Mode of Delivery on Long-Term Outcomes in Patients With Perianal Crohn's Disease

2014 ◽  
Vol 146 (5) ◽  
pp. S-598
Author(s):  
Alice G. Cheng ◽  
Emily Oxford ◽  
Deanna D. Nguyen ◽  
Jenny Sauk ◽  
Vijay Yajnik ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Mode Of Delivery ◽  
Long Term Outcomes ◽  
Perianal Crohn’S Disease ◽  
The Impact ◽  
Perianal Crohn's Disease

Imaging Modalities for Perianal Crohn’s Disease

2012 ◽  
Vol 13 (10) ◽  
pp. 1287-1293 ◽  
Author(s):  
Antonino Spinelli ◽  
Chiara De Cassan ◽  
Matteo Sacchi ◽  
Piero Bazzi ◽  
Silvio Danese ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Imaging Modalities ◽  
Perianal Crohn’S Disease ◽  
Perianal Crohn's Disease

scholarly journals Anastomotic Ulcers After Ileocolic Resection for Crohn’s Disease Are Common and Predict Recurrence

2019 ◽  
Vol 26 (7) ◽  
pp. 1050-1058 ◽  
Author(s):  
Robert P Hirten ◽  
Ryan C Ungaro ◽  
Daniel Castaneda ◽  
Sarah Lopatin ◽  
Bruce E Sands ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Multivariable Analysis ◽  
Disease Recurrence ◽  
Ileocolic Resection ◽  
Anastomotic Ulcer ◽  
Endoscopic Recurrence ◽  
Academic Center ◽  
Endoscopic Remission ◽  
The Impact

Abstract Background Crohn’s disease recurrence after ileocolic resection is common and graded with the Rutgeerts score. There is controversy whether anastomotic ulcers represent disease recurrence and should be included in the grading system. The aim of this study was to determine the impact of anastomotic ulcers on Crohn’s disease recurrence in patients with prior ileocolic resections. Secondary aims included defining the prevalence of anastomotic ulcers, risk factors for development, and their natural history. Methods We conducted a retrospective cohort study of patients undergoing an ileocolic resection between 2008 and 2017 at a large academic center, with a postoperative colonoscopy assessing the neoterminal ileum and ileocolic anastomosis. The primary outcome was disease recurrence defined as endoscopic recurrence (&gt;5 ulcers in the neoterminal ileum) or need for another ileocolic resection among patients with or without an anastomotic ulcer in endoscopic remission. Results One hundred eighty-two subjects with Crohn’s disease and an ileocolic resection were included. Anastomotic ulcers were present in 95 (52.2%) subjects. No factors were associated with anastomotic ulcer development. One hundred eleven patients were in endoscopic remission on the first postoperative colonoscopy. On multivariable analysis, anastomotic ulcers were associated with disease recurrence (adjusted hazard ratio [aHR] 3.64; 95% CI, 1.21–10.95; P = 0.02). Sixty-six subjects with anastomotic ulcers underwent a second colonoscopy, with 31 patients (79.5%) having persistent ulcers independent of medication escalation. Conclusion Anastomotic ulcers occur in over half of Crohn’s disease patients after ileocolic resection. No factors are associated with their development. They are associated with Crohn’s disease recurrence and are persistent.

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