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Perianal Crohn's disease findings other than fistulas in a population-based cohort
Laurent Peyrin-Biroulet1, Edward V Loftus, William J Tremaine
1Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Background:
The cumulative incidence of and risk factors for perianal Crohn's disease (CD) for findings other than fistulas are unknown.
Methods:
The medical records of 310 incident cases of CD from Olmsted County, Minnesota, diagnosed between 1970 and 2004, were reviewed for evidence of perianal disease findings other than fistulas. Cumulative incidence was estimated using the Kaplan-Meier method, and associations between baseline factors and time to first event were assessed using proportional hazards regression. Four types of lesions were studied: anorectal strictures, deep anal canal ulcers, anal fissures, and perianal skin tags.
Results:
The 10-year cumulative probability from time of diagnosis was 5.8% (95% confidence interval [CI], 2.6%-8.8%) for anorectal strictures, 6.6% (3.6%-9.6%) for deep anal canal ulcers, 10.5% (6.8%-14.1%) for anal fissures, and 18.7% (13.9%-23.3%) for perianal skin tags. The cumulative probability for any perianal lesion other than fistulas was 21.3% (16.5%-25.8%) at 5 years and 29.2% (23.5%-34.5%) at 10 years. Baseline factors associated with time to first perianal lesion other than fistulas were age (hazard ratio [HR] per 10 years, 0.9; 95% CI, 0.8-0.98; P = 0.026), female gender (HR, 1.7; 95% CI, 1.1-2.7; P = 0.013), and presence of extraintestinal manifestations (HR, 1.7; 95% CI, 1.03-2.8; P = 0.038).
Conclusions:
Perianal lesions other than fistulas occurred frequently during the clinical course of CD. Female gender and extraintestinal manifestations were associated with increased risks for perianal lesions other than fistulas, while older age at diagnosis was associated with a slightly decreased risk.
Insights
Perianal Crohn's disease (CD) lesions, excluding fistulas, are common, affecting nearly 30% of patients within 10 years. Female gender and extraintestinal manifestations increase risk, while older age at diagnosis slightly decreases it.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Perianal Crohn's disease (CD) encompasses various manifestations beyond fistulas.
- The incidence and risk factors for these non-fistulizing perianal lesions in CD are not well-established.
Purpose of the Study:
- To determine the cumulative incidence of non-fistulizing perianal lesions in Crohn's disease.
- To identify baseline risk factors associated with the development of these lesions.
Main Methods:
- Retrospective review of 310 incident Crohn's disease cases diagnosed between 1970 and 2004.
- Kaplan-Meier method for cumulative incidence estimation.
- Proportional hazards regression to assess associations between baseline factors and time to first perianal lesion (strictures, ulcers, fissures, skin tags).
Main Results:
- 10-year cumulative probabilities: 5.8% for anorectal strictures, 6.6% for deep anal ulcers, 10.5% for anal fissures, and 18.7% for perianal skin tags.
- Overall cumulative probability for any non-fistulizing perianal lesion reached 29.2% at 10 years.
- Increased risk associated with female gender (HR 1.7) and extraintestinal manifestations (HR 1.7); decreased risk with older age at diagnosis (HR 0.9 per 10 years).
Conclusions:
- Non-fistulizing perianal lesions are frequent occurrences in the clinical progression of Crohn's disease.
- Female sex and the presence of extraintestinal manifestations are significant risk factors.
- Older age at diagnosis is associated with a marginally reduced risk for these perianal complications.
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