scholarly journals P238 Natural history of perianal fistulizing Crohn’s disease in the Swiss IBD cohort

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
N Aslan ◽  
J B Rossel ◽  
V Pittet ◽  
E Safroneeva ◽  
S Godat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Natural History ◽  
Disease Duration ◽  
Perianal Fistula ◽  
Rectal Disease ◽  
Perianal Fistulas ◽  
History Of

Abstract Background Data of large cohort studies on the fate of perianal fistulizing Crohn’s disease (CD) is scarce. We aimed to evaluate the prevalence and natural history of perianal fistulas in adults with Crohn’s disease (CD). Methods Data from the Swiss IBD cohort study were analysed. The Swiss IBD Cohort study includes since 2006 IBD patients, follow-up questionnaires are completed once a year. Patients were recruited from university centres (80%), regional hospitals (19%), and private practices (1%). Results Among 2163 CD patients, 495 (22.9%) ever had perianal fistulas whereas 1668 (77.1%) did not. Patients with perianal fistulas were characterised by the following features when compared with patients without perianal fistulas: younger age at diagnosis (23.4 vs. 25.3 years, p = 0.001), longer disease duration at enrolment (9.6 vs. 4.9 years, p < 0.001), longer disease duration at latest follow-up (17.4 vs. 11.2 years, p < 0.001), less frequenty isolated ileal disease at diagnosis (15.8% vs. 28.6%, p < 0.001), more frequently rectal disease at enrolment (32.5% vs. 14.8%, p < 0.001) and latest follow-up (24.2% vs. 11.7%, p < 0.001), more frequently acne inversa (1.4% vs. 0.1%, p < 0.001), and more frequently intestinal resection (49.5% vs. 35.3%, p < 0.001). The prevalence of extraintestinal manifestations was not different (59.0% vs. 54.4%, p = 0.073). Compared with patients without perianal fistulas, patients with perianal fistulas were more frequently treated with topical 5-ASA (14.8% vs. 8.0%, p < 0.001), systemic steroids (78.2% vs. 70.1%, p < 0.001), azathioprine (82.6% vs. 77%, p = 0.008), methotrexate (28.3% vs. 22.2%, p = 0.005), infliximab (71.9% vs. 50.8%, p < 0.001), adalimumab (36% vs. 27.9%, p < 0.001), certolizumab pegol (18.6% vs. 11.5%, p < 0.001), and antibiotics (69.1% vs. 41.2%, p < 0.001). Regarding fistula anatomy, 321 patients (64.8%) had a low perianal fistula, 82 (16.6%) a high perianal fistula, and 227 (45.9%) a perineal fistula. The following fistula therapies were ever applied: perianal abscess drainage (45.7%), fistulectomy/fistulotomy (39.6%), seton drainage (28.7%), mucosal sliding flap (2%), fistula plug (1.4%), and fibrin glue instillation (1%). Conclusion In our national cohort roughly one-quarter of CD patients was diagnosed with perianal fistulizing disease. Compared with patients without perianal fistulas, patients with perianal fistulizing disease were characterised by several stigmata of complicated disease course such as a higher frequency of intestinal resections and higher prevalence of treatment with biologic agents.

Mo1806 Natural History of Perianal Crohn's Disease: Long-Term Follow-Up on a Population-Based Cohort

2016 ◽  
Vol 150 (4) ◽  
pp. S781-S782
Author(s):  
Rabilloud Marie-Laure ◽  
Charlène Brochard ◽  
Emma Bajeux ◽  
Siproudhis Laurent ◽  
Jean-François Viel ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Natural History ◽  
Population Based ◽  
Perianal Crohn’S Disease ◽  
Long Term Follow Up ◽  
History Of ◽  
Perianal Crohn's Disease

scholarly journals P240 CDEIS score of 2 is optimal cut-off associated with lower risk of disease progression in early Crohn’s disease: Data from the CALM study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S264-S266
Author(s):  
R Ungaro ◽  
R Jordan ◽  
C Yzet ◽  
P Bossuyt ◽  
F Baert ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Progression ◽  
Lower Risk ◽  
Perianal Fistula ◽  
Youden Index ◽  
History Of ◽  
Risk Of Disease ◽  
Over Time

Abstract Background The optimal endoscopic target in early Crohn’s disease (CD) that limits long-term disease complications is unknown. Methods We analysed medical records from patients who had follow-up data since the end of CALM. Patients with Crohn’s disease endoscopic index of severity (CDEIS) scores at the end of CALM were included. The primary outcome was a composite of major adverse outcomes reflecting CD progression: new internal fistula/abscess, stricture, perianal fistula/abscess, CD hospitalisation, or CD surgery since the end of CALM. We compared median CDEIS and per cent improvement from baseline CDEIS. Youden index analysis was used to identify optimal CDEIS cut-off score associated with CD progression. Kaplan–Meier and Cox regression methods were used to compare rates of progression by different CDEIS targets. Multivariable models were adjusted for age, prior surgery, and stricturing behaviour. Results 110 patients with median age 28 (IQR 22–38) years, disease duration 0.2 (0.1–0.5) years, and median follow up of 3.1 (1.9–4.4) years were included. Eleven per cent had a history of stricture, 5.5% history of surgery, and 52% were originally in the tight control arm of the CALM study. Median CDEIS score at end of CALM was 3 (0–5.4) and 32 (29%) patients had disease progression. Baseline median CDEIS score was similar between those with and without progression [10.9 (7.5–15.5) vs. 11.9 (8–17.5)]. Median CDEIS score at the end of CALM was higher among those with progression [1.3 (0–5.1) vs. 4.9 (3–9.1), p < 0.001)]. Patients within higher quartiles of CDEIS score had higher rates of progression over time (Figure 1). Patients without disease progression had a greater median decrease in CDEIS score from baseline to end of CALM [90% (60–100%) vs. 50% (30–80%), p < 0.001]. The optimal CDEIS score cut-off was 2 with sensitivity 84%, specificity 60% and NPV 90% for progression. Patients with CDEIS ≤ 2 had less progression over time compared with patients with > 50% improvement from baseline CDEIS (not reaching CDEIS ≤ 2) and those not meeting either endpoint (Figure 2). On adjusted analysis, CDEIS score ≤ 2 was associated with a decreased risk of progression (aHR 0.23, 95% CI 0.09–0.56). Conclusion In early CD, a CDEIS score ≤ 2 is optimal cut-off associated with a lower risk of disease progression.

Natural History of Pediatric Crohn's Disease: A Population-Based Cohort Study

2008 ◽  
Vol 135 (4) ◽  
pp. 1106-1113 ◽  
Author(s):  
Gwenola Vernier–Massouille ◽  
Mamadou Balde ◽  
Julia Salleron ◽  
Dominique Turck ◽  
Jean Louis Dupas ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Natural History ◽  
Population Based ◽  
History Of

Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn’s Disease: A Population-based Study

2019 ◽  
Vol 14 (4) ◽  
pp. 501-507 ◽  
Author(s):  
Marie Danielou ◽  
Hélène Sarter ◽  
Benjamin Pariente ◽  
Mathurin Fumery ◽  
Delphine Ley ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Natural History ◽  
Elderly Patients ◽  
Control Method ◽  
Population Based ◽  
Cox Models ◽  
History Of ◽  
Elderly Onset

Abstract Introduction Most studies of elderly-onset Crohn’s disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD. Method All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD. Results A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10–4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6–5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up. Conclusion During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

scholarly journals P199 Analysis of clinical features of asymptomatic perianal fistulizing Crohn’s disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S264-S264
Author(s):  
T Wu ◽  
L Huang ◽  
Q Cao
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Features ◽  
Disease Duration ◽  
Perianal Fistula ◽  
Perianal Abscess ◽  
Perianal Fistulas ◽  
Female Sex ◽  
Bowel Surgery ◽  
Laboratory Examinations

Abstract Background Perianal fistula represents an aggressive phenotype of Crohn’s disease (CD), and is detected in CD patients without perianal complains. Data of CD patients with asymptomatic perianal fistula is scarce. Our study targets to assess the clinical characteristics of adult CD patients with asymptomatic perianal fistulas in adults with CD. Methods This retrospectively study collected data from Sir Run Run Shaw Hospital. Newly diagnosed CD patients undergoing magnetic resonance imaging examinations during 2014–2019 were enrolled. The perianal fistulizing CD patients were divided into two groups: 1) symptomatic perianal fistula group, 2) asymptomatic perianal fistula group, then we analyze the features of clinical features, medication and prognosis of each group. Results Among 437 CD patients, 346 (79.2%) had perianal fistulas whereas 91 (20.8%) did not. In patients with perianal fistulas, 89 (25.7%) did not have perianal symptoms. Comparing to symptomatic perianal fistula group, asymptomatic perianal fistula group combined with lower perianal abscess incidence (73.9% vs. 25.8%, p < 0.001). According to Park’s classification, the most common type of fistula in these two groups was intersphincteric fistula (73.2% vs. 53.2% p=0.094). Patients with asymptomatic perianal fistulas were described by the following features when compared with patients with symptomatic perianal fistulas: higher rate of female sex (38.2% vs. 17.9%, p < 0.001), shorter disease duration at enrolment (0.8 vs. 1.0 years, p = 0.001), higher rate of stricturing behavior (32.6% vs. 18.7%, p < 0.01), worse outcomes of laboratory examinations at diagnosis, including hemoglobin (119.0 vs. 131.0 g/dL, p < 0.001), platelet (333.0 vs. 283.0 *10^9, p < 0.001), ESR (20.0 vs. 14.0 mm/H, p < 0.01), albumin (35.6 vs. 37.5 g/L, p = 0.001), C-reactive protein (27.3 vs. 15.7 mg/L, p = 0.001). The age at diagnosis and disease locations were not different. For asymptomatic perianal fistula patients, antibiotics (57.3%) and surgery (6.7%) were taken at diagnosis. The usage of biologics at diagnosis showed no difference (59.6% vs. 40.4% p=0.108). Regarding clinical outcomes, the cumulative probabilities for bowel surgery (p < 0.05) and bowel obstruction (p < 0.01) in asymptomatic perianal fistula group were higher than symptomatic perianal fistula group. Conclusion Asymptomatic perianal fistulas account for a certain proportion. Female sex, shorter disease duration, stricturing behavior and poor outcomes of laboratory examinations at diagnosis are associated with detection of asymptomatic perianal fistulas. We should pay more attention to CD patients with asymptomatic perianal fistulas because they may have poor prognosis or even worse as patients with symptomatic perianal fistulas.

scholarly journals Sa1249 The Natural History of Crohn's Disease: A Long-Term (> 10 Years) Follow-up Study

2012 ◽  
Vol 142 (5) ◽  
pp. S-254
Author(s):  
Fernando Casals-Seoane ◽  
Maria Chaparro ◽  
Javier P. Gisbert
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Natural History ◽  
Follow Up Study ◽  
History Of
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