Treffer: Significant Medical and Surgical Morbidity in Perianal Crohn's Disease: Results from a Territory-Wide Study.

Title:
Significant Medical and Surgical Morbidity in Perianal Crohn's Disease: Results from a Territory-Wide Study.
Authors:
Mak WY; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong., Mak OS; Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong., Lee CK; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong.; Gastroenterology Unit, Department of Medicine, Hospital Pulau Pinang, Pulau Pinang, Malaysia., Tang W; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong., Leung WK; Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong., Wong MTL; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong., Sze ASF; Department of Medicine, Queen Elizabeth Hospital, Hong Kong., Li M; Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong., Leung CM; Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong., Lo FH; Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong., Lam BCY; Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong., Chan KH; Department of Medicine, North District Hospital, Hong Kong., Shan EHS; Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong., Tsang SWC; Department of Medicine, Tseung Kwan O Hospital, Hong Kong., Hui AJ; Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong., Chow WH; Department of Medicine, Yan Chai Hospital, Hong Kong., Chan FKL; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong., Sung JJY; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong., Ng SC; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong.
Source:
Journal of Crohn's & colitis [J Crohns Colitis] 2018 Nov 28; Vol. 12 (12), pp. 1392-1398.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Oxford University Press Country of Publication: England NLM ID: 101318676 Publication Model: Print Cited Medium: Internet ISSN: 1876-4479 (Electronic) Linking ISSN: 18739946 NLM ISO Abbreviation: J Crohns Colitis Subsets: MEDLINE
Imprint Name(s):
Publication: 2015- : Oxford : Oxford University Press
Original Publication: Amsterdam : Elsevier Science
MeSH Terms:
Anus Diseases*/complications , Anus Diseases*/diagnosis , Anus Diseases*/epidemiology , Colectomy*/adverse effects , Colectomy*/methods , Colectomy*/statistics & numerical data , Crohn Disease*/complications , Crohn Disease*/diagnosis , Crohn Disease*/epidemiology , Rectal Fistula*/diagnosis , Rectal Fistula*/epidemiology , Rectal Fistula*/etiology, Anti-Bacterial Agents/*therapeutic use , Biological Products/*therapeutic use, Adult ; Age Factors ; Female ; Hong Kong/epidemiology ; Humans ; Kaplan-Meier Estimate ; Male ; Outcome Assessment, Health Care ; Patient Care Management/methods ; Patient Care Management/statistics & numerical data ; Risk Factors ; Severity of Illness Index ; Sex Factors
Substance Nomenclature:
0 (Anti-Bacterial Agents)
0 (Biological Products)
Entry Date(s):
Date Created: 20180831 Date Completed: 20190320 Latest Revision: 20220330
Update Code:
20250114
DOI:
10.1093/ecco-jcc/jjy120
PMID:
30165543
Database:
MEDLINE

Weitere Informationen

Background: The presence of perianal fistulas in Crohn's disease [CD] denotes increased disease aggressiveness. We studied the epidemiology and clinical outcomes of perianal CD [PCD] using the Hong Kong territory-wide IBD Registry [HKIBDR].
Methods: Consecutive patients with PCD were identified from the HKIBDR, and disease characteristics, treatments, and outcomes were analysed. The risks for medical and surgical therapies were assessed using Kaplan-Meier analysis.
Results: Among 981 patients with CD with 10530 patient-years of follow-up, 283 [28.8%] had perianal involvement, of which 120 [42.4%] were as first presentation. The mean age at diagnosis of PCD was 29.1 years, and 78.8% were male. The median follow-up duration was 106 months (interquartile range [IQR]: 65-161 months]. Perianal fistula [84.8%] and perianal abscess [52.7%] were the two commonest forms. Male, younger age at diagnosis of CD, and penetrating phenotypes were associated with development of PCD in multivariate analysis. Of 242 patients with fistulizing PCD, 70 [29.2%] required ≥5 courses of antibiotics, and 98 [40.5%] had ≥2 surgical procedures. Nine patients required defunctioning surgery and 4 required proctectomy. Eighty-four patients [34.7%] received biologics. Cumulative probabilities for use of biologics were 4.7%, 5.8%, and 8.6% at 12 months, 36 months, and 96 months, respectively, while the probabilities for surgery were 67.2%, 71.6%, and 77.7%, respectively. Five mortalities were recorded, including 2 cases of anal cancer, 2 CD-related complications, and one case of pneumonia.
Conclusion: Over 40% of CD patients presented with perianal disease at diagnosis. Patients with PCD had poor outcome, with young age of onset, multiple antibiotic use, and repeated surgery.