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[Perineal lesions in childhood Crohn disease]
M Bellaiche1, M Besnard, C Faure
1Service de gastroentérologie et nutrition pédiatriques, hôpital Robert-Debré, Paris, France.
Insights
Perineal lesions (PAL) are a common and disabling complication in pediatric Crohn's disease. Fissures are the most common PAL, and while medical and surgical treatments can lead to healing, relapses are frequent.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Perianal Disease Studies
Context:
- Perineal lesions (PAL) are a significant complication in Crohn's disease, impacting quality of life.
- Understanding the epidemiology and clinical course of PAL in pediatric Crohn's disease is crucial for effective management.
Purpose:
- To investigate the incidence, characteristics, and outcomes of perineal lesions in children with Crohn's disease.
- To analyze the association of PAL with gastrointestinal involvement and disease course.
- To evaluate the efficacy of medical and surgical treatments for PAL in this population.
Summary:
- A retrospective study of 92 pediatric Crohn's disease patients found 43% developed PAL, most commonly fissures.
- PAL presentation varied from mild (eczema, fissures) to severe (complex fistulae, abscesses), with a significant association with rectosigmoid involvement.
- While 41% of PAL healed with medical treatment and 83% with surgery, relapse rates were high (35% medical, 86% surgical).
Impact:
- This study highlights the high prevalence and challenging nature of perineal lesions in pediatric Crohn's disease.
- Findings underscore the need for tailored treatment strategies to improve healing rates and reduce relapse frequency.
- Provides valuable data for clinicians managing pediatric Crohn's disease patients with perianal manifestations.
Background:
Perineal lesions (PAL) usually evolve together with bowel disease and often constitute a serious and disabling complication of Crohn's disease.
Patients:
Forty-three children (47%) with Crohn's disease developed PAL in a retrospective study of 92 patients ranging in age from 4 to 20 years.
Results:
PAL occurred at the mean age of 11.4 +/- 0.7 years, prior to diagnosis in 25% or subsequently in 21%. PAL were severe: complex fistulae (15%), rectovaginal fistulae (2%), anal raggedness (13%); moderate: subcutaneous fistulae (11%), abscesses (19%), cavitating ulcers (9.5%) and stricture formations (5.7%); or mild: eczema (6.7%), fissures (57%) and skin tags (17%). An association with these various features has been observed in 31%. The extent of involvement of the gastrointestinal tract was rectosigmoid (72%), ileal and colonic (41%), ileal with pancolitis (12%). Two PAL course profiles were observed: one with exacerbation and remissions (52%), the other without remission (48%), especially anal raggedness (100%), cavitating ulcers (80%) and skin tags (61%). Medical treatment included steroids (54%), metronidazole (53%), salicylates (51%), nutritional support (44%), azathioprine (17%). PAL healed in 41%. Surgical treatment was performed in 27% with 83% of healing. Relapses occurred in 35% after medical treatment and 86% after surgery.