Significant medical and surgical morbidity in perianal Crohn’s disease: Results from a territory-wide study

Abstract

BACKGROUND: Presence of perianal fistulas in Crohn's disease (CD) denotes increased disease aggressiveness. We studied epidemiology and clinical outcomes of perianal CD (PCD) using Hong Kong territory-wide IBD Registry (HKIBDR). METHODS: Consecutive patients with PCD were identified from HKIBDR. Disease characteristics, treatments and outcomes were analysed. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. RESULTS: Among 981 patients with CD with 10,530 patient-years follow-up, 283 (28.8%) had perianal involvement, of which 120 (42.4%) were as first presentation. Mean age at diagnosis of PCD was 29.1 years old and 78.8% were male. Median follow-up duration was 106 months (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. Among 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 while that for surgery were 67.2%, 71.6% and 77.7% at 12 months, 36 months and 96 months respectively. Five mortalities were recorded, including 2 anal cancer, 2 CD-related complications and one case of pneumonia. CONCLUSION: Over 40% CD patients presented with perianal disease at diagnosis. Chinese patients with PCD had poor outcomes, with young age of onset, multiple antibiotic use and repeated surgery.