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Factors Associated with Fistulizing Crohn's Disease in Children at Diagnosis: A Cross-Sectional Study
Yi Fan Lin1,2, Alicia Truchon1,2, Boris Djoukam Mbuko1,3
1CHU Sainte-Justine Research Center, Montreal, QC, Canada.
Insights
Perianal fistulizing Crohn's disease (PFCD) affects nearly half of pediatric Crohn's patients, with male sex, granulomas, and fissures indicating higher risk and severity. Early MRI is crucial for detecting occult PFCD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Diagnostic Imaging in Crohn's Disease
Background:
- Perianal manifestations are common in pediatric Crohn's Disease (CD).
- Perianal fistulizing Crohn's Disease (PFCD) is linked to poorer outcomes in children.
- Identifying early indicators of PFCD is critical for timely intervention.
Purpose of the Study:
- To determine factors associated with PFCD at diagnosis in pediatric CD patients.
- To assess factors influencing PFCD severity using the Van Assche score.
- To characterize PFCD prevalence and management in a Canadian cohort.
Main Methods:
- Retrospective data collection from pediatric CD patients (ages 4-18) diagnosed between 2009-2021.
- Perineal MRI performed within three months of diagnosis for all included patients.
- Clinical assessment and MRI findings were used to evaluate perianal CD and PFCD.
Main Results:
- 46.8% of 489 pediatric CD patients had perianal CD; 23.5% had PFCD.
- 13.0% of PFCD cases were initially occult, detected only by MRI.
- Male sex, intestinal granulomas, and anal fissures correlated with PFCD presence and severity.
Conclusions:
- Early perianal MRI is vital for diagnosing occult PFCD in pediatric Crohn's Disease.
- Male sex, granulomas, and anal fissures are key indicators for PFCD risk and severity.
- Findings highlight the need for comprehensive perianal assessment at diagnosis.
Background:
Perianal manifestations are common at diagnosis of Crohn's Disease and include perianal fistulas, abscesses, fissures, and inflammatory anal skin tags. Perianal fistulizing Crohn's disease (PFCD), involving fistulas and abscesses, is associated with a poor prognosis in children.This study aimed to identify the factors associated with PFCD at diagnosis. Secondary aims were to: assess factors associated with the severity of PFCD according to the Van Assche score, characterize the prevalence of perianal Crohn's disease in a Canadian cohort, and evaluate its management at diagnosis.
Methods:
We collected data from patients aged 4-18 years diagnosed with Crohn's disease between 2009 and 2021 at our IBD center who underwent perineal magnetic resonance imaging within three months of diagnosis. Perianal Crohn's disease was assessed clinically and through MRI results.
Results:
Among 489 patients (57.9% male, median age 13.8 years), 229 (46.8%) had perianal Crohn's disease. Perianal fistulizing Crohn's disease was identified in 115 patients (23.5%), including 13.0% without any clinical signs. The median Van Assche score was 13.0 in patients with PFCD versus 2.0 in those without. Male sex, granulomas on intestinal biopsies, and anal fissures were associated with both the presence and increased severity of PFCD.
Conclusion:
This study emphasizes the importance of performing perianal MRI early at the diagnosis as occult perianal fistulizing Crohn's disease may be discovered. Male sex, granulomas on intestinal biopsies and anal fissures were associated both with the presence of PFCD and increased severity.
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