Abstract
Background and aimsThe significance of different ages of perianal disease (PD) onset in patients with perianal Crohn’s disease (PCD) remains unknown. We aimed to investigate the impact of paediatric-onset PD (POP) and adult-onset PD (AOP) on the Crohn’s disease (CD) course in a Chinese cohort.MethodsThe medical records of diagnosed PCD patients from 2008 to 2018 were reviewed retrospectively. The cumulative incidence and predictors of intestinal resection were calculated using the Kaplan–Meier and logistic regression analysis.ResultsComplex perianal fistulas (71.7% vs 50.0%, p = 0.011) and infliximab (IFX) treatment (33.3% vs 22.0%, p = 0.044) were more common among the POP patients (age < 18 years old, n = 84). A younger PD onset age (15.1 ± 2.9 vs 30.2 ± 10.5 years, p < 0.001) and shorter PCD diagnostic delay (12 vs 24 months, p = 0.033) was found in the POP cohort. AOP patients (age ≥ 18 years old, n = 209) had a higher rate of current smoking (12.9% vs 4.8%, p = 0.040), stricturing behaviour (42.1% vs 27.4%, p = 0.024) and intestinal resection (21.1% vs 4.8%, p = 0.001). The cumulative probability of intestinal resection in AOP patients was higher than that in POP patients (p = 0.007). In multivariable analysis, AOP (OR: 4.939, 95% CI 1.538–15.855, p = 0.007), stricturing behaviour (OR: 1.810, 95% CI 1.008–3.251, p = 0.047) and rectal inflammation (OR: 3.166, 95% CI 1.119–8.959, p = 0.030) were predictive factors for CD-related intestinal resection in all PCD patients. AOP patients with complex perianal fistula (OR: 2.257, 95% CI 1.041–4.891, p = 0.039) and POP patients with rectal inflammation (OR: 3.166, 95% CI 1.119–8.959, p = 0.030) were more likely to suffer intestinal resection. The IFX administration significantly decreased the rate of intestinal resection in AOP patients (r = − 0.900, p = 0.037).ConclusionsThe AOP patients have more complicated luminal disease and higher rate of intestinal resection than COP patients. The perianal diseases onset-age can provide clinical treatment guidance for individual management of CD patients.
Highlights
Crohn’s disease (CD) is a multifactorial systemic inflammatory bowel disease (IBD) with a heterogeneous clinical course
There was a gradual increase in the diagnosis of paediatric-onset PD (POP) in perianal Crohn’s disease (PCD) patients from 2008.1 to 2017.12 but a reduction in the diagnosis of patients with adultonset PD (AOP) during the same period (Fig. 1)
We found that CD patients who developed perianal disease (PD) during childhood had a more serious perianal phenotype and earlier PCD diagnosis and IFX treatment, while aggressive luminal disease, current smoking and a higher rate of intestinal resection were more common in AOP patients
Summary
Crohn’s disease (CD) is a multifactorial systemic inflammatory bowel disease (IBD) with a heterogeneous clinical course. The successful development of various anti-tumour necrosis factor (TNF)-α agents (the first biological agents for CD in the world) breaks this impasse. Due to their rapid efficacy in cases of complicated PD and luminal lesions, anti-TNF agents, including infliximab (IFX) and adalimumab, are recommended as the first-line treatment for CD patients who have high-risk factors for poor outcomes, including PD, onset age < 40 years, and extensive small bowel involvement [4,5,6,7,8,9,10]. The significance of different ages of perianal disease (PD) onset in patients with perianal Crohn’s disease (PCD) remains unknown. We aimed to investigate the impact of paediatric-onset PD (POP) and adultonset PD (AOP) on the Crohn’s disease (CD) course in a Chinese cohort
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