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The Risk of Inflammatory Bowel Disease in Subjects Presenting With Perianal Abscess: Findings From the THIN Database
Tom Thomas1, Joht S Chandan1, Philip R Harvey2
1Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Insights
Individuals diagnosed with a perianal abscess face a significantly higher risk of developing inflammatory bowel disease, specifically Crohn's disease and ulcerative colitis. Early investigation for IBD is recommended for patients with diarrhea and anemia post-perianal abscess.
Area of Science:
- Gastroenterology
- Proctology
- Epidemiology
Background:
- Perianal abscess (PA) is a known complication associated with inflammatory bowel disease (IBD).
- The incidence of IBD following a PA diagnosis and its predictive factors remain largely unknown.
- This study investigates the link between PA and subsequent IBD development.
Purpose of the Study:
- To determine the risk of developing Crohn's Disease (CD) or ulcerative colitis (UC) after a perianal abscess diagnosis.
- To identify potential predictors for a future IBD diagnosis in patients with a history of PA.
Main Methods:
- Utilized The Health Improvement Network (THIN) primary care database (UK) from 1995-2017.
- Matched incident PA cases with controls within the same general practices.
- Employed Cox regression to analyze predictors of subsequent CD or UC diagnoses.
Main Results:
- The PA cohort showed a significantly higher risk for CD (aHR 7.51) and UC (aHR 2.03) compared to controls.
- Predictors for CD included anemia in men and antidiarrheal medication use.
- Predictors for UC included anemia in men, diarrhea, and antidiarrheal medication use.
Conclusions:
- Patients with a perianal abscess have an elevated risk of developing Crohn's Disease and ulcerative colitis.
- Consider IBD investigation in young patients with diarrhea and anemia (males) post-PA.
- Further research is needed to establish screening strategies for this high-risk group.
Background:
Perianal abscess [PA] is associated with inflammatory bowel disease [IBD]. The incidence of IBD after a diagnosis of PA and potential predictors of a future diagnosis of IBD are unknown.
Methods:
The Health Improvement Network [THIN] is a primary care database representative of the UK population. Incident cases of PA were identified between 1995 and 2017. Subjects with PA were matched to controls within the same general practice. The primary outcome was a subsequent diagnosis of Crohn's Disease [CD] or ulcerative colitis [UC]. A Cox regression model was used to assess potential predictors of a new diagnosis of CD or UC following PA.
Results:
The risk of CD was higher in the PA cohort compared with controls; adjusted hazard ratio [HR] 7.51 (95% confidence interval [CI] 4.86-11.62), p < 0.0001. The risk of UC was also higher in the PA cohort compared with controls; adjusted HR 2.03 [1.38-2.99], p < 0.0001. Anaemia in men (HR 2.82 [1.34-5.92], p = 0.002), and use of antidiarrhoeal medications (HR 2.70 [1.71-4.25], p < 0.0001) were associated with an increased risk of CD following PA. Anaemia in men (HR 2.58 [1.09-6.07], p = 0.03), diarrhoea (HR 2.18 [1.23-3.85], p = 0.007), and use of anti-diarrhoeal medication (HR 2.27 [1.19-4.30], p = 0.012) were associated with an increased risk of UC following PA.
Conclusion:
Subjects with PA are at an increased risk of subsequent diagnosis of CD and UC. Clinicians should strongly consider investigation for IBD in young patients presenting with diarrhoea and anaemia [in males] following PA. Future research should discern appropriate screening strategies for this high-risk cohort.
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