Korean J Intern Med.
2024 May;39(3):430-438. 10.3904/kjim.2023.410.
Self-screening questionnaire for perianal fistulizing disease in patients with Crohn’s disease
- Kweon OS1
- Kang B2
- Lee YJ3
- Kim ES
1 - Kim SK1
- Lee HS1
- Chung YJ1
- Kim KO4
- Jang BI4
- on behalf of Crohn’s Colitis Association in Daegu-Gyeongbuk (CCAiD)1
- Affiliations
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- 1Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
- 2Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
- 3Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- 4Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
- KMID: 2554888
- DOI: http://doi.org/10.3904/kjim.2023.410
Abstract
- Background/Aims
A poor prognostic factor for Crohn’s disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess perianal symptoms in patients with CD remains nonexistent. This study aimed to develop a perianal fistulizing disease self-screening questionnaire for patients with CD.
Methods
This prospective pilot study was conducted at three tertiary referral centers between January 2019 and May 2020. We formulated questions on perianal symptoms, including tenesmus, anal discharge, bleeding, pain, and heat. A 4-point Likert scale was used to rate each question. Patients with CD completed a questionnaire and underwent pelvic magnetic resonance imaging (MRI).
Results
Overall, 93 patients were enrolled, with 51 (54.8%) diagnosed with perianal fistulizing disease, as determined by pelvic MRI. The Spearman correlation findings demonstrated that anal pain (p = 0.450, p < 0.001) and anal discharge (p = 0.556, p < 0.001) were the symptoms that most significantly correlated with perianal disease. For anal pain and discharge, the area under the receiver operating characteristic curve of the scores was significantly higher than that of the combined score for all five symptoms (0.855 vs. 0.794, DeLong’s test p = 0.04). For the two symptoms combined, the sensitivity, specificity, and positive predictive and negative predictive values were 88.2, 73.8, 80.4, and 83.8%, respectively, with 81.7% accuracy for detecting perianal fistulizing disease.
Conclusions
This study indicates that simple questions regarding anal pain and discharge can help accurately identify the presence of perianal fistulizing disease in patients with CD.
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