Gut Liver.  2018 Sep;12(5):544-554. 10.5009/gnl18157.

Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn’s Disease in Korea: Results from the CONNECT Study

Affiliations
  • 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. kjwjor@snu.ac.kr
  • 3Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
  • 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.
  • 9Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 10Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea.

Abstract

BACKGROUND/AIMS
The disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population.
METHODS
The retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for < 12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses.
RESULTS
The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses.
CONCLUSIONS
Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.

Keyword

Anal fistula; Crohn disease; Prognosis
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