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Perianal Disease in Pediatric-Onset Crohn's Disease: Incidence, Disease Course, and Long-Term Outcomes
Annika Ström1, Sabine Jansson1, Mads Damsgaard Wewer2
1Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents, and Adults, Amager and Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Insights
Pediatric Crohn's disease (CD) frequently leads to perianal disease, affecting over 30% of patients. Those with perianal CD face increased risks of major surgery and stoma necessity.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Epidemiology
Background:
- Perianal Crohn's disease (CD) involves fistulae and abscesses, causing significant patient morbidity.
- Understanding the incidence and disease course in pediatric-onset CD is crucial for management.
Purpose of the Study:
- To estimate the incidence of perianal disease in pediatric-onset Crohn's disease.
- To describe the disease course and associated risks in this patient population.
Main Methods:
- Nationwide registry-based study of patients diagnosed with pediatric-onset CD (<18 years) from 1980-2018.
- Cumulative incidence calculated; Cox regression used to assess risks of surgery, cancer, and mortality.
- Adjusted hazard ratios (aHR) accounted for sex, income, and diagnosis year.
Main Results:
- 32.6% of 2356 pediatric CD patients developed perianal disease.
- 30-year cumulative incidence reached 45.2%; abscesses (59.8%) and fistulas (51.9%) were common.
- Perianal CD increased risks for major abdominal surgery (aHR 1.5) and stoma (aHR 2.8).
Conclusions:
- Perianal disease is highly incident in pediatric-onset Crohn's disease.
- Patients with perianal disease experience elevated risks for major abdominal surgery and stoma requirements compared to those without.
Background & Aims:
Perianal Crohn's disease (CD) is characterized by fistulae and/or abscesses in the anal region and leads to significant morbidity. We aimed to estimate the incidence and describe the disease course of perianal disease in pediatric-onset CD.
Methods:
In a nationwide registry-based study, we included patients diagnosed with pediatric-onset CD (<18 years) between 1980 and 2018. Cumulative incidence of perianal disease was calculated. Cox regression was used to assess the risks of major abdominal surgeries, colorectal cancer, and mortality. Hazard ratios were adjusted (aHR) for sex, family income, and year of CD diagnosis.
Results:
We identified 2356 patients with pediatric-onset CD, of whom 769 (32.6%) developed perianal CD. The cumulative incidence of perianal CD was 14.0%, 21.1%, and 28.1% after 1, 5, and 10 years. The incidence rate was 28.8 per 1000 person-years (95% confidence interval [CI], 26.8-30.9), corresponding to 45.2% after 30 years. Perianal abscesses developed in 460 patients (59.8%) and fistulas in 399 (51.9%). When comparing patients with/without perianal disease, the aHR for major abdominal surgery, cancer, and mortality were 1.5 (95% CI, 1.3-1.8), 0.8 (95% CI, 0.2-2.7), and 1.5 (95% CI, 0.9-2.7). A stoma was required in 308 (40.1%) and 147 (9.3%) patients with and without perianal disease, respectively (aHR, 2.8; 95% CI, 2.3‒3.4). Of mortalities, 35 had perianal disease (4.6%; mortality rate, 2.2/1000 person-years) and 33 did not (2.1%; mortality rate, 1.4/1000 person-years).
Conclusions:
We report a high incidence of perianal disease in pediatric-onset CD. Patients with perianal disease had higher risks of major abdominal surgery and requiring stomas than patients without perianal CD.
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