THE IMPACT OF OBESITY ON THE PREVALENCE AND SEVERITY OF PERIANAL COMPLICATIONS OF CROHN'S DISEASE

Abstract

Abstract INTRODUCTION The incidence of obesity in patients with inflammatory bowel disease (IBD) is increasing and there is limited data on the effects of obesity on disease phenotype. Several studies have investigated the association of obesity with perianal fistulizing disease with conflicting results. In this study, we aim to examine the relationship between obesity and the prevalence and severity of perianal complications in patients with Crohn’s disease (CD). METHODS We conducted a cross-sectional study of CD patients treated at a tertiary care center from 2012 to 2022. Collected data included sex, race, smoking history, family history, maximum body mass index (BMI), and Montreal classification (Table 1). Obesity was defined as maximum BMI ≥30kg/m2 and further subdivided into 5 BMI categories (Table 2). The prevalence of perianal disease was defined by a history of perianal fistula. The severity of perianal disease was measured by four variables including history of perianal fistula surgery, number of perianal surgeries, history of fecal diversion, and median time to first anal surgery. Perianal fistula surgeries included abscess incision and drainage, seton placement, fistulectomy, and/or fistulotomy. Pearson’s chi-squared test was used to compare 2 categorical variables (non-obese vs obese). Exact Cochran-Armitage trend test was used to compare 5 BMI categorical variables. A 95% confidence interval was used with an alpha of 0.5. Values of p <0.05 was considered statistically significant. Data analysis was performed using Excel. RESULTS A total of 704 patients with CD were treated. In all, 68.9% were non-obese and 31.1% were obese. Furthermore, 2.8% were underweight, 36.5% normal weight, 29.5% overweight, 17.9% obese, and 13.2% severely obese. Non-obese patients were more likely to have a family history of IBD (p=0.043). Obese patients were more likely to have extraintestinal manifestations (p=0.004) and/or be former smokers (p=0.004). There was no significant association between obesity and prevalence of perianal fistula (p=0.719), history of perianal surgery (p=0.146), history of one or more perianal surgeries (p=0.220), history of fecal diversion (p=0.705) or median time to first perianal surgery (p=0.192) (Table 1). Increasing BMI category was not associated with the prevalence of perianal fistula (p=0.944), perianal surgery (p=0.583), more than one perianal surgery (p=0.114), fecal diversion (p=0.542) or median time to first perianal surgery (p=0.486) (Table 2). DISCUSSION In conclusion, there was no significant correlation between obesity and prevalence of perianal disease. Additionally, there was no significant correlation between obesity and severity of perianal disease. The overall impact of obesity on CD complications is still unknown and warrants further investigation.