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A child presents with perianal symptoms - how often is this Crohn's disease?
Gillian R Goddard1, Irene Isabel P Lim1, Yu-Chia Cheng1
1Colorectal Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States.
Insights
Three percent of children with perianal symptoms are diagnosed with Crohn's disease (CD). Older males with perianal fistulas face the highest risk, necessitating prompt evaluation for early CD diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- The link between perianal symptoms and future Crohn's disease (CD) diagnosis in children is not well-established.
- Understanding the incidence and predictors of CD following perianal symptom presentation is crucial for early detection.
Purpose of the Study:
- To determine the cumulative incidence of Crohn's disease (CD) in children presenting with perianal symptoms.
- To identify predictors for future CD diagnosis in this pediatric cohort.
Main Methods:
- A 5-year retrospective review was conducted on children presenting with perianal symptoms (abscess, fistula, fissure) without a prior CD diagnosis.
- Institutional cumulative incidence of CD was calculated.
Main Results:
- Out of 1140 children, 35 were diagnosed with CD, yielding an incidence of 3%.
- Predictors for CD included older age (RR 1.19), male sex (RR 2.12), and perianal fistula (RR 4.67).
- Delayed diagnosis occurred in cases with absent prior CD symptoms (43 vs 3 days).
Conclusions:
- Approximately 3% of children with perianal symptoms will be diagnosed with Crohn's disease.
- Males aged 10+ with perianal fistulas are at the highest risk (35%), warranting expedited workup.
Background:
The cumulative incidence and predictors of future diagnosis of Crohn's disease (CD) following presentation with perianal symptoms, such as anorectal abscess, fistula or fissure, is unknown.
Methods:
A 5-year retrospective review of children presenting with perianal symptoms without prior CD diagnosis was performed. Institutional cumulative incidence of CD was calculated to determine the risk of CD presenting with perianal symptoms.
Results:
1140 children presented for evaluation of an anorectal abscess (n = 232), fistula (n = 49), or fissure (n = 859). Thirty-five were later diagnosed with CD, resulting in an incidence of 3%. Prognostic indicators of future CD diagnosis included increased age per every additional year (RR 1.19, 95% CI: 1.14-1.25, p < 0.001), male sex (RR 2.12, 95% CI 1.07-4.22, p = 0.024), or perianal fistula (RR 4.67, 95% CI 2.26-9.67, p = 0.022). Among those diagnosed with CD, 57% experienced and had a documented history of a CD-associated symptom prior to perianal symptom onset. Absence of symptoms resulted in delayed diagnosis (43 vs 3 days, p < 0.02).
Conclusion:
Of children presenting with a perianal symptom, three percent will eventually be diagnosed with CD. At highest risk (35%) were males aged 10 years or older with a perianal fistula; which should prompt expeditious workup.
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