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Perianal Crohn’s linked to higher risk for surgery, hospitalization
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Patients with perianal Crohn’s disease tend to experience a more severe disease course and worse prognosis even as biologic therapies are becoming more common, according to research published in Inflammatory Bowel Diseases.
With their study, Johan Bursich, MD, PhD, of the gastro unit at Copenhagen University Hospital in Denmark, and colleagues sought to determine the occurrence, clinical risk factors and disease course of perianal CD in the biologic era.
“Perianal surgery and medical treatment alone are often unsuccessful at inducing sustainable healing, and abdominal surgery is required in about 25% to 30% of cases,” they wrote. “The frequent need for surgery and the symptoms associated with perianal disease, such as discharge, pain, and fecal incontinence, impair the patients’ social and sexual life and have a negative impact on general quality of life.”
Researchers included 213 patients with CD in the prospective population-based cohort study. They analyzed data from medical records and databases to assess for perianal disease defined as perianal fistula or abscess.
After 10 years of follow-up, 48 patients developed perianal disease (22.5%). Patients with colonic disease location (HR = 1.99; 95% CI, 1.01–3.92) and penetrating behavior (HR = 5.65; 95% CI, 2.65–12.03) had higher risk for developing perianal disease.
The cumulative risk for undergoing abdominal surgery was 51% after 10 years, and patients with perianal disease had a higher rate of resection (HR = 3.92; 95% CI, 1.86–8.67) and hospitalizations (HR = 1.01; 95% CI, 1–1.01).
Bursich and colleagues wrote that their findings show that patients with perianal CD have a more severe disease course and require optimized treatment strategies.
“We found a higher risk of abdominal surgery, in particular, intestinal resections and reoperation, and a higher rate of hospitalization in patients who developed perianal disease,” they wrote. “Thus, the prognosis in patients with [perianal CD] is still poor despite advances in their medical treatment.” – by Alex Young
Disclosures: Bursich reports personal fees from AbbVie, Janssen-Cilag, Celgene, MSD, and Pfizer, as well as grants and personal fees from Takeda. Please see the full study for all other authors’ relevant financial disclosures.
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