OP12 The incidence and disease course of perianal Crohn’s disease: A Danish nationwide cohort study

Abstract Background Perianal Crohn’s disease (pCD) has a major negative impact on patients’ quality of life and is complex to treat. Despite its putative high frequency and burden for patients, only a few studies have investigated the incidence, disease course and associated cancer-risk in a population-based setting. The aim was to assess the incidence and course of pCD in adult patients with CD within a 19-year period. Specifically, describing changes in medical and surgical management as well as rates of cancer. Methods The cohort comprised all individuals >18 years diagnosed with CD in Denmark between 1 January 1997 and 31 December 2015. Patients were identified in the National Patient Registry. Chi-square test, Mann–Whitney–Wilcoxon test and multivariate Cox regression analysis were used. Results A total of 1,697/9,739 (17%) patients with CD were found to have pCD. Perianal fistulas were the most common manifestation accounting for 943 (56%) cases. The onset of pCD before CD diagnosis occurred in 32%. The overall incidence of pCD was 20/1,000 patient-years. The incidence of pCD remained stable over time. More patients with pCD were treated with immunomodulators (70%) and biologics (35%) than those without pCD (51%, p < 0.001 and 15%, p < 0.001, respectively). Defunctioning stoma was performed in 157/943 (17%) of perianal fistula patients. Stoma formation in relation to resection was performed in 112/943 (12%) of perianal fistula patients. Patients with pCD were found to have a significantly increased risk of undergoing major abdominal surgery compared with patients without pCD (hazard ratio: 1.52, 95% CI: 1.40 to 1.65, p < 0.001). The incidence rate ratios of anal and rectal cancer in pCD patients were 12.46 (95% CI: 5.07 to 30.59, p < 0.001) and 2.41 (95% CI: 1.31 to 4.42, p = 0.003) respectively, when compared with non-IBD matched controls. The incidence rate ratio of anal and rectal cancer in pCD patients was 2.36 (95% CI: 0.86 to 6.50, p = 0.09) and 1.35 (95% CI: 0.68 to 2.68, p = 0.38) respectively, when compared with CD patients without pCD. Conclusion In this nationwide study, 17% of the CD patients developed pCD. The continuing high incidence of pCD suggests a limited disease-modifying effect of biologics. Patients with pCD were at increased risk of undergoing major surgery compared with non-pCD patients. The risk of rectal or anal cancer was increased in patients with pCD compared with non-IBD matched controls. These findings encourage surveillance of rectal and anal cancer.

Download Full-text

The Incidence and Disease Course of Perianal Crohn’s Disease: A Danish Nationwide Cohort Study, 1997–2015

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa118 ◽

2020 ◽

Author(s):

M D Wewer ◽

M Zhao ◽

A Nordholm-Carstensen ◽

P Weimers ◽

J B Seidelin ◽

...

Keyword(s):

Rectal Cancer ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Cox Regression ◽

Major Surgery ◽

Disease Course ◽

Cox Regression Analysis ◽

Perianal Crohn’S Disease ◽

Increased Risk ◽

Perianal Crohn's Disease

Abstract Background and Aims Perianal Crohn’s disease [CD] places a considerable burden on patients’ quality of life and is complex to treat. Despite its impact and high frequency, few studies have investigated the incidence and disease course of perianal CD. The aim of this study was to assess the incidence and disease course of perianal CD in adult patients throughout a 19-year period. Methods The cohort comprised all individuals aged 18 years or older who were diagnosed with CD in Denmark between January 1, 1997, and December 31, 2015, according to the National Patient Registry [NPR]. Results A total of 1812 [19%] out of 9739 patients with CD were found to have perianal CD. Perianal fistulas were the most common manifestation, accounting for 943 [52%] cases. The incidence of perianal CD remained stable over time. Patients with perianal CD were found to have an increased risk of undergoing major abdominal surgery compared with patients without perianal CD (hazard ratio: 1.51, 95% confidence interval [CI]: 1.40 to 1.64, p <0.001) in a multivariate Cox regression analysis. The incidence rate ratios of anal and rectal cancer in perianal CD patients were 11.45 [95% CI: 4.70 to 27.91, p <0.001] and 2.29 [95% CI: 1.25 to 4.20, p = 0.006], respectively, as compared with non-IBD matched controls. Conclusions In this nationwide study, 19% of CD patients developed perianal disease. Patients with perianal CD were at increased risk of undergoing major surgery compared with non-perianal CD patients. The risk of anal and rectal cancer was increased in patients with perianal CD compared with non-IBD matched controls. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast

Download Full-text

P813 Occurrence, disease course and prognosis of perianal Crohn’s disease in a Danish population-based inception cohort—a 10-year follow-up study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx180.940 ◽

2018 ◽

Vol 12 (supplement_1) ◽

pp. S524-S525 ◽

Cited By ~ 1

Author(s):

M Zhao ◽

B Lo ◽

M Vester-Andersen ◽

I Vind ◽

F Bendtsen ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Population Based ◽

Disease Course ◽

Inception Cohort ◽

Danish Population ◽

Perianal Crohn’S Disease ◽

Follow Up Study ◽

Perianal Crohn's Disease

Download Full-text

Video anoscopy: results of routine anal examination during colonoscopies

Endoscopy International Open ◽

10.1055/a-0998-3958 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1549-E1562

Author(s):

Alexandre Gomes ◽

Maurício Kazuyoshi Minata ◽

José Jukemura ◽

Eduardo Guimarães Hourneaux de Moura

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Perianal Fistula ◽

Cross Sectional Study ◽

Hemorrhoidal Disease ◽

Anal Stenosis ◽

Cross Sectional ◽

Perianal Crohn’S Disease ◽

Internal Hemorrhoids ◽

Perianal Crohn's Disease

Abstract Background and study aims Anal examination and video anoscopy (VA) are rarely performed during colonoscopies. The aim of this study is to demonstrate that anal examination and VA provide important information in all routine colonoscopies. Patients and methods A cross-sectional study was conducted on 12,151 patients screened by VA which were performed during routine outpatient colonoscopy between 2006 and 2018. The aspects studied were: normal examination; hemorrhoidal disease; thrombosed hemorrhoids; anal fissure; perianal Crohn’s Disease; perianal fistula; condyloma; polyps; neoplasms; stenosis; bleeding. Results Of the colonoscopies performed on 12,151 patients, 9,364 cases (77.06 %) presented some alterations. Internal I degree hemorrhoids (5911 – 48.65 %); internal hemorrhoids of II, III and IV degrees (2362 – 19.44 %); thrombosed hemorrhoids (120 – 0.99 %); bleeding (56 – 0.46 %); fissure (415 – 3.42 %); perianal fistula (42 – 0.35 %); perianal Crohn’s Disease (34 – 0.28 %); condylomas (18 – 0.15 %); anal stenosis (30 – 0.25 %); other findings (310 – 2.55 %); polyps (62 – 0.51 %), one of which was adenomatous with high-grade dysplasia; four cases of anal canal neoplasia (0.03 %): two cases of squamous cell carcinoma and two cases of adenocarcinoma. Conclusion The association of routine video anoscopy during colonoscopy improved diagnosis of neoplastic anal lesions, allowed correct classification of the degree of hemorrhoidal disease, helped to confirm the bleeding site and detected other anal pathologies. The main findings were hemorrhoidal diseases, fissures and perianal fistulas. The study suggests that VA should be used in all colonoscopies.

Download Full-text

High Risk of Anal and Rectal Cancer in Patients With Anal and/or Perianal Crohn’s Disease

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2017.11.041 ◽

2018 ◽

Vol 16 (6) ◽

pp. 892-899.e2 ◽

Cited By ~ 28

Author(s):

Laurent Beaugerie ◽

Fabrice Carrat ◽

Stéphane Nahon ◽

Jean-David Zeitoun ◽

Jean-Marc Sabaté ◽

...

Keyword(s):

Rectal Cancer ◽

Crohn’S Disease ◽

High Risk ◽

Crohn's Disease ◽

Perianal Crohn’S Disease ◽

Perianal Crohn's Disease

Download Full-text

P586 Higher infliximab and adalimumab trough levels are associated with fistula healing in patients with fistulising perianal Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.714 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S490-S491

Author(s):

B GU ◽

K Venkatesh ◽

A J Williams ◽

W Ng ◽

C Corte ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Perianal Fistula ◽

Secondary Outcome ◽

Fistula Closure ◽

Roc Curve Analysis ◽

Perianal Crohn’S Disease ◽

Fistula Healing ◽

Trough Levels ◽

Perianal Crohn's Disease

Abstract Background Anti-TNF α agents, including infliximab (IFX) and adalimumab (ADA), are arguably the most effective medical therapies for fistulising perianal Crohn’s disease (CD). Increased rates of perianal fistula healing have been reported with increased IFX trough levels. Our study aimed to determine the correlation between perianal fistula healing and closure with IFX and ADA trough levels in fistulising perianal CD patients on maintenance therapy. Methods In this multi-centre retrospective cross-sectional study, we identified CD patients with perianal fistulae on maintenance IFX or ADA who had an IFX or ADA trough level within 3 months of clinical assessment. Data collected included demographics, serum IFX and ADA trough levels (mg/l) and concomitant medical and surgical therapy. The primary outcome was fistula healing, defined as a cessation in fistula drainage. The secondary outcome was fistula closure, defined as healing as well as closure of all external fistula openings. Receiver operating characteristic (ROC) curve analysis was performed to identify the IFX and ADA concentration cut-off points with combined maximal sensitivity and specificity that corresponded to fistula healing. Results A total of 123 patients (IFX = 72; ADA = 51) were included. Fifty-four (75.0%) patients on maintenance IFX achieved fistula healing and 22 (30.6%) achieved fistula closure. Patients who achieved fistula healing had significantly higher median IFX trough levels compared with patients who did not [6.2 (interquartile range 3.1 - 9.6) vs. 3.0 (0.3 - 6.2), (p = 0.007)]. The median IFX trough levels for patients with and without fistula closure were not significantly different [6.4 (2.9 - 9.8) vs. 4.9 (2.5 - 8.9), (p = 0.277)]. Forty (78.4%) patients on maintenance ADA achieved fistula healing and eighteen (35.3%) fistula closure. Patients who achieved fistula healing had a significantly higher median ADA level compared with those who did not [8.7 (6.6 - 12.0) vs. 5.4 (2.5 - 8.3), p = 0.007]. The median ADA trough levels for patients with fistula closure and without fistula closure were not significantly different [9.6 (6.7 – 12.0) vs. 7.7 (4.4–9.8), p = 0.098]. An IFX cut off point of 6.10mg/l was associated with healing (sensitivity 52%; specificity 78%; area under the curve (AUC) 0.72). An ADA cut off point of 7.05mg/l was associated with healing (sensitivity 70%; specificity 73%; AUC 0.77). Conclusion Higher IFX and ADA trough levels are associated with fistula healing. No association between IFX and ADA trough levels and fistula closure was seen, although larger numbers may be required. To the best our knowledge, this is the first study to demonstrate a significant association with both higher IFX and ADA levels with fistula healing in perianal CD.

Download Full-text

P762 Prevalence association between HPV and fistulising perianal Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.890 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S606-S607

Author(s):

L RODRIGUES BOARINI ◽

C W Sobrado ◽

V R Guzela ◽

A Pozzebon Gonçalves ◽

L Lina Villa ◽

...

Keyword(s):

Crohn’S Disease ◽

High Risk ◽

Crohn's Disease ◽

Surgical Intervention ◽

Perianal Fistula ◽

Epidemiological Studies ◽

Hpv Infection ◽

Fistula Tract ◽

Perianal Crohn’S Disease ◽

Perianal Crohn's Disease

Abstract Background Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (SCC). The incidence of SCC in PCD patients is 0.26 per 1000 patients-years, affects females more than males, develops on average at 42 years of age, which is earlier than general population. Although epidemiological studies have shown that most anal cancers are associated with HPV infection, predominantly oncogenic types 16 and 18.1 prevalence of HPV on perianal Crohn`s disease (PCD) remains unknown. We aimed to estimate the Prevalence of HPV and the subtypes more frequently associated with PCD. Methods Adults with fistulising PCD under immunosuppressed medications who have required surgical intervention, were transversally recruited. A biopsy sample was obtained from perianal fistula tract during under anesthesia exam. INNO-LiPA test was performed on paraffin blocks containing fistula path for HPV testing. Results A total number of 45 PCD patients were recruited and underwent surgical intervention. All patients were under biologic therapy, 42.2% Adalimumab, 40.1% Infliximab, 11.1% Certolizumab, 4.4% Ustekinumab and 2.2% Vedolizumab. The prevalence of fistula tract HPV infection in PCD patients was 37.8% and 22.2% for high-risk HPV in particular. The subtypes more frequently identified were HPV-11 (15.5%), HPV-16 (8.9%) and HPV-53 (6.7%). Conclusion This study shows a high point-prevalence of HPV, specially high-risk subtypes in fistulising PCD population. More studies are necessary to define a screening for cancer in this population.

Download Full-text