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 P229 Is quality-of-life worse in perianal Crohn's disease patients?

2013 ◽  
Vol 7 ◽  
pp. S101
Author(s):  
M. Barreiro-de Acosta ◽  
M. Iglesias-Rey ◽  
A. Lorenzo ◽  
J.E. Dominguez-Munoz
Keyword(s):  
Quality Of Life ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perianal Crohn’S Disease ◽  
Perianal Crohn's Disease

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.

Modern Management of Perianal Crohn’s Disease: A Review

2020 ◽  
pp. 000313482095633
Author(s):  
Jennifer L. Williams ◽  
Virginia O. Shaffer
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Poor Quality ◽  
Future Directions ◽  
Perianal Crohn’S Disease ◽  
Mild Disease ◽  
Work Up ◽  
Necrosis Factor ◽  
Perianal Crohn's Disease

Perianal Crohn’s disease (CD) is a complex manifestation of CD that affects approximately 10% of patients. The spectrum of disease is quite variable, ranging from relatively mild disease to severe, aggressive manifestations that result in frequent hospitalizations, multiple surgeries, and poor quality of life. Despite significant recent advances in surgical and medical management, treatment remains challenging and frequently requires a multidisciplinary medical-surgical approach. The goal of this article is to review the current literature regarding the work-up, treatment, and future directions of therapy. Crucial features of effective management include the precise identification of manifestations, control of sepsis, limiting rectal inflammation, frequently with use of antitumor necrosis factor agents, and avoidance of extensive surgery.

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 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.

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
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