Age at Diagnosis: Is It a Predictor for Development of Perianal and Fistulizing Crohnʼs Disease?

Abstract

Introduction: Both perianal and fistulizing Crohn's disease (CD) can cause significant morbidity and complications in patients with CD, irrespective of their age, gender, and race. A number of risk factors, including age of the patient at diagnosis, genetic composition, and disease extent and location, have been implicated in the development of perianal and fistulizing CD. The primary aim of our study is to determine if younger age at diagnosis of CD and duration of CD portray an increased risk for the development of perianal and fistulizing disease in patients with CD. In addition, we aim to analyze the difference in the risk of development of perianal and fistulizing CD with respect to the race of the patients (Caucasians and African Americans (AA)). Methods: We conducted a retrospective cohort study of patients with CD at a tertiary care center analyzing the age at diagnosis of CD in patients with perianal and fistulizing disease compared to the age at diagnosis of CD in patients without perianal and fistulizing disease. Results: 300 patients with CD were assessed. 23.7% (71) had perianal disease and 19.7% (59) had fistulizing disease. Of the patients with perianal disease, 25.4% (18) were AA. Of the patients with fistulizing disease, 15.3% (9) were AA. In both AA and Caucasian patients, younger age at diagnosis increased the risk for the development of perianal and fistulizing disease, OR=1.16 (p=0.004, 95% CI= 1.06, 1.26) and OR= 1.19 (p= 0.002, 95%CI= 1.08, 1.30), respectively. When adjusted for race, longer CD duration increased the risk for perianal (15% increased risk for every 5 years disease duration), OR=1.15 (p=0.019, 95%CI=1.02, 1.29) but had no effect on fistulizing disease, OR=1.08 (p=0.231). Conclusion: Younger age at CD diagnosis increases the risk for the development of perianal and fistulizing disease in both AA and Caucasian patients. Longer duration of CD increases the risk for perianal, but not fistulizing Crohn's disease.