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Predictors of Perianal Fistula Healing in Children With Newly Diagnosed Crohn Disease
Andrew A M Singer1, Annemarie Rompca2, Samir K Gadepalli3,4
1From the Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
Insights
Perianal fistulas in pediatric Crohn disease heal slower with certain surgeries and non-White race. Anti-tumor necrosis factor (TNF)α therapy plus drug monitoring speeds healing.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Surgical Outcomes Analysis
Background:
- Perianal fistulas are severe Crohn disease complications with limited pediatric data.
- Identifying predictors of fistula healing is crucial for optimizing pediatric Crohn disease management.
Purpose of the Study:
- To determine predictors of perianal fistula healing in children newly diagnosed with Crohn disease.
- To analyze factors influencing time to fistula healing in pediatric Crohn disease patients.
Main Methods:
- Retrospective single-center study of pediatric patients with perianal fistulas at diagnosis.
- Cox proportional hazard regression models analyzed time to healing, considering demographics, disease characteristics, medical therapies (including anti-tumor necrosis factor (TNF)α therapy with/without drug monitoring), and surgical procedures.
Main Results:
- Perianal fistulotomy, fistulectomy, lesion removal, non-White race, and male sex were linked to delayed fistula healing.
- Anti-tumor necrosis factor (TNF)α therapy combined with therapeutic drug monitoring significantly accelerated fistula healing (HR 1.78, P = 0.009).
Conclusions:
- Surgical interventions like fistulotomy and fistulectomy, along with non-White race, are associated with slower perianal fistula healing in pediatric Crohn disease.
- Anti-tumor necrosis factor (TNF)α therapy with therapeutic drug monitoring demonstrates superior efficacy in promoting faster fistula healing compared to other treatments.
Objectives:
Perianal fistulas are among the most severe complications of Crohn disease, but limited data regarding their outcomes are available in children. Our objective was to determine predictors of perianal fistula healing among pediatric patients newly diagnosed with Crohn disease.
Methods:
This single-center retrospective study followed patients with perianal fistulas at Crohn disease diagnosis until fistula healing. Time to healing was analyzed using Cox proportional hazard regression models considering relevant covariates including patient demographics, disease characteristics, medical therapies [no anti-tumor necrosis factor (TNF)α therapy, anti-TNFα therapy ±therapeutic drug monitoring], and perianal surgical procedures including fistulotomy, fistulectomy, removal of perianal lesions, seton placement, and incision and drainage.
Results:
Of 485 patients identified, 107 (22%) had a perianal fistula at Crohn disease diagnosis. Multivariate analysis identified that perianal fistulotomy, fistulectomy, and lesion removal [hazard ratio (HR) 0.46; P = 0.028], non-White race (HR 0.30, P < 0.01), and male sex (HR 0.42; P = 0.02) were associated with delayed fistula healing. Faster fistula healing was associated with treatment with anti-TNFα with therapeutic drug monitoring (HR 1.78, P = 0.009). There were no other differences in healing by treatment.
Conclusions:
Fistulotomy, fistulectomy, and perianal lesion removal as well as non-White race were associated with delayed fistula healing. Anti-TNFα therapy was associated with faster fistula healing when combined with therapeutic drug monitoring, compared to all other medical treatment groups, including anti-TNFα therapy without therapeutic drug monitoring.
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