Intest Res.  2024 Oct;22(4):484-495. 10.5217/ir.2024.00021.

Perianal fistulizing lesions of Crohn’s disease are associated with long-term behavior and its transition: a Chinese cohort study

• Zhan W
• Bai X
• Yang H
• Qian J

• KMID: 2560298
• DOI: http://doi.org/10.5217/ir.2024.00021

Abstract

Background/Aims
Crohn’s disease (CD) has a progressive nature and commonly perianal involvement. The aim of this study is to assess the prevalence, surgical treatment, and outcome of perianal fistulizing CD with associated risk factors in a large Chinese cohort.
Methods
Hospitalized patients diagnosed with CD in our center were consecutively enrolled between January 2000 and December 2018. Transition of disease behavior was classified according to the presence or absence of penetrating behavior (B3 in the Montreal classification) at diagnosis and at a median follow-up of 102 months.
Results
A total of 504 patients were included, of whom 207 (41.1%) were classified as B3 and 348 (69.0%) as L2/3 at follow-up. Transition of behavior to B3 was observed in 86 patients (17.1%). The incidence of perianal fistulizing lesions was 10.9% at 10 years with a final prevalence of 27.0% (n = 136) at the end of follow-up. Multivariate Cox regression identified independent risks of perianal fistulizing lesions for persistent B3 (hazard ratio, 4.72; 95% confidence interval, 1.91–11.66) and behavior transition of progressed to B3 (hazard ratio, 9.90; 95% confidence interval, 4.60–21.33). Perianal surgical treatments were performed in 104 patients (20.6%). Thirty-six cases (7.1%) were refractory, and it is independently associated with behavior of persistent B3 (P= 0.011).
Conclusions
Perianal fistulizing lesions occurred frequently in Chinese CD patients. Its incidence and refractory outcome were closely associated with the penetrating CD behavior. An additional risk of perianal fistulizing lesions was indicated for CD patients with behavior of progressing to B3, suggesting further attention.

Keyword

Crohn disease; Rectal diseases; Intestinal fistula; Disease progression

Figure

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  Fig. 1. Alluvial plot of perianal fistulizing lesions with transitional nature of Crohn’s disease (CD). (A) Transition trends of CD behavior. (B) Transition trends of CD location. Transition trends of CD were presented as the flows connecting CD behavior/location from diagnosis to end of follow-up. The flow was colored differently if perianal fistulizing lesions occurred at any time from baseline to the end of followup course (perianal fistulizing lesions=yes). The Montreal classification is as follows: behavior classification (B1, unstructured, non-invasive; B2, structured; B3, infiltrating) and location classification (L1, ileum; L2, colon; L3, ileocolic; L4, isolated upper disease).

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  Fig. 2. Cumulative percentage of perianal fistulizing lesions after diagnosis of Crohn’s disease (CD). The cumulative percentage of developing perianal fistulizing lesion was 2.7% at 1 year, 7.2% at 5 years, 10.9% at 10 years, and 16.6% at 20 years after diagnosis of CD.

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  Fig. 3. Comparison of cumulative percentage of perianal fistulizing lesions after diagnosis with different Crohn’s disease (CD) behavior. (A) Comparison at diagnosis. (B) Comparison at follow-up. (C) Comparison according to different transition trends of CD behavior. Classification of CD behavior was categorized as B3 (penetrating) or non-B3 (nonstricturing/nonpenetrating or stricturing) according to the Montreal classification [20]. Note that pairwise log-rank tests for each of the 2 categories of B3 trends indicates significant differences (P<0.001 for non-B3 with progressed to B3, P=0.012 for non-B3 with persistent B3, and P=0.036 for persistent B3 with progressed to B3).

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