Development Of Perianal Disease Research Articles

A Case Report of Ulcerative Colitis Presenting with Perianal Disease in 78-Years-Old Female Patient

Introduction: IBD usually presents with different phenotypes, which may include the presence of perianal disease. Although perianal disease is typical for patients with Crohn's disease, we should always pay the attention to the possibility of perianal disrase presence (hemorrhoids, anal fissure and/or fistula, perianal abscess) in patients with ulcerative colitis. In a certain number of patients with Crohn's disease, the perianal fistulas develop before the intestinal disease and the occurrence of perianal disease prior to development of ulcerative colitis is very rare. Case presentation: We report a case of a 78-year-old female patient who was admitted to our hospital with the complaints of perianal pain, fever, rectal bleeding, abdominal cramps and progressively worsening bloody diarrhea. The results of diagnostic work-up was consistent with the diagnosis of ulcerative colitis and the presence of perianal disease in a form of anal fissure an rectocutaneous fistula. The treatment included the combination therapy of antibiotics, corticosteroids, 5-ASA compounds, and parenteral supplementation of packed erythrocytes, albumins and iron. Conclusion: In presented older female patient with ulcerative colitis, the perianal disease was healed with combination therapy of antibiotics, corticosteroids and 5-ASA compounds, reflecting the difference in pathogenesis, clinical course and therapeutic response, compared to the nature of perianal disease in patients with Crohn's disease. The alternation of chronic constipation and diarrhea could be of pathogenetic influence in development of perianal disease, in this particular patient with ulcerative colitis.

P060 Is the thickness of the psoas muscle a marker of poor prognosis in Crohn's disease?

INTRODUCTION: Recent studies point to an association between body composition and clinical outcomes in Crohn's disease (CD). OBJECTIVE: To determine the relationship between psoas muscle thickness (PSOAS) as a marker of nutritional status and the prognosis of patients with CD. METHODS: Retrospective study, including patients with CD who underwent computed tomography (CT) at diagnosis and with a minimum follow-up of 1 year. The axial (AT) and transverse (TT) thickness of the right PSOAS was measured at the cross-sectional level of L3-L4. AT corresponds to the maximum diameter of the PSOAS on the axial axis. TT corresponds to the diameter of the PSOAS perpendicular to the axial diameter. The thickness was normalized for height. Poor prognosis was defined as the need for surgery and/or introduction of immunosuppressive therapy and/or development of perianal disease and/or altered disease behavior. RESULTS: Included 104 patients, 62 (59.6%) female with a mean age at diagnosis of 33.9 ± 12.17 years. Patients were submitted to surgery in 37.5%. We observed a behavior change in 15.4%, development of perianal disease in 22.1% and introduction of immunosuppressive therapy in 76.9%. We found that patients who underwent surgery had lower values ​​of AT (25.23 vs 26.78 mm/m; P = 0.024) and TT (18.70 vs 20.69 mm/m; P = 0.008). The same was observed in patients who presented change in the disease behavior of AT (24.44 vs 26.51 mm/m; P = 0.024) and TT (17.43 vs 20.40 mm/m; P = 0.003). CONCLUSIONS: We identified that patients submitted to surgery or with behavior change had lower values ​​of AT and TT at diagnosis. These parameters may identify patients with CD who may progress with worse prognosis, and constitute an extra tool in monitoring patients with CD.

A 10-Year Follow-up Study of the Natural History of Perianal Crohn's Disease in a Danish Population-Based Inception Cohort.

Perianal complications in patients with Crohn's disease are common and have a negative impact on the patients' quality of life. Data about the long-term disease course of perianal Crohn's disease in the era of biological treatment are limited. In this population-based cohort study, we sought to investigate the occurrence, clinical risk factors, and disease course of perianal disease. A total of 213 Crohn's disease patients were included in a prospective population-based inception cohort. Data were retrieved from medical records and national health administrative databases. Perianal disease was defined as a perianal fistula and/or abscess. Associations between outcomes and covariates were analyzed by Cox regression analysis. A total of 48 (22.5%) patients developed perianal disease after 10 years. Colonic disease location (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.01-3.92) and penetrating behavior (HR, 5.65; 95% CI, 2.65-12.03) were associated with the development of perianal disease. The cumulative risk of undergoing abdominal surgery was 51% after 10 years. Patients with perianal disease had a higher rate of resection (HR, 3.92; 95% CI, 1.86-8.67) and hospitalization (HR, 1.01; 95% CI, 1.00-1.01). There was no significant difference in the rate of sick leave, unemployment, or disability pension between patients with and without perianal disease. Patients with perianal disease carry a higher risk of surgery and hospitalization, and this suggests a more severe disease course and poorer prognosis among these patients, even in the era of biological treatment. These findings underline the importance of optimizing treatment strategies for patients with perianal disease.

Perianal Crohn Disease in a Large Multicenter Pediatric Collaborative.

Although perianal complications of Crohn disease (CD) are commonly encountered in clinical practice, the epidemiology of perianal CD among populations of children is poorly understood. We sought to characterize the prevalence of perianal disease in a large and diverse population of pediatric patients with CD. We conducted retrospective analyses from a prospective observational cohort, the ImproveCareNow Network (May 2006-October 2014), a multicenter pediatric inflammatory bowel disease quality improvement collaborative. Clinicians prospectively documented physical examination and phenotype classification at outpatient visits. Perianal examination findings and concomitant phenotype change were used to corroborate time of new-onset perianal disease. Results were stratified by age, sex, and race and compared across groups with logistic regression. Cumulative incidence was estimated using Kaplan-Meier analyses and compared between groups with Cox proportional hazard regression models. The registry included 7076 patients with CD (41% girls). Missing/conflicting entries resulted in 397 (6%) patient exclusions. Among the remaining 6679 cases, 1399 (21%) developed perianal disease. Perianal disease was more common among boys (22%) than girls (20%; P = 0.013) and developed sooner after diagnosis among those with later rather than early onset disease (P < 0.001). Perianal disease was also more common among blacks (26%) compared with whites (20%; P = 0.017). Asians with later onset CD developed perianal disease earlier in their disease course (P = 0.01). There was no association between disease location or nutritional status at diagnosis and later development of perianal disease. In this large multicenter collaborative, we found that perianal disease is more common among children with CD than previously recognized. Differences in the development of perianal disease were found across racial and other subgroups. Treatment strategies are needed to prevent perianal disease development.

Su1753 Primary Response to Infliximab in Crohn's Disease Is Associated With the Tnfrsf1a Rs1800693 Gene Polymorphism

desert was also associated with perianal disease (rs10092418, p = 8×10 6). Conclusions:We report novel genetic and serologic associations with perianal disease in a large cohort of Crohn’s disease patients. The association between perianal disease and a locus near MYC, which encodes a transcription factor with broad activity in cell proliferation, apoptosis, and differentiation, suggests novel mechanisms in the development of perianal disease. Replication will be important to confirm findings and direct further investigation into this unique Crohn’s disease phenotype. *Dr. Murdoch and Dr. Weizman contributed equally to this study.

839 Development of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease: Significant Association With Presence of Psychiatric Illness and Early Onset IBD

genome-wide association study (GWAS) using Illumina OmniExpress, comparing patients with and without perianal disease (n=780). Serum was analyzed by ELISA for anti-Saccharomyces cerevisiae (ASCA), anti-outer membrane porin C (anti-OmpC), anti-Cbir1, and antiPseudomonas fluorescens (anti-I2). Data analysis was undertaken using univariate logistic regression for clinical and serologic data (statistical significance at p ,0.001). Multivariate regression was used for GWAS data, with principal components/disease location as covariates. We report single nucleotide polymorphisms (SNPs) that reached p=10E-6. Results: Perianal disease was documented in 35% (n=297). Perianal disease was associated with colonic and ileocolonic disease locations (p,0.0001), as well as with upper GI (p=0.0006) and rectal disease (p,0.0001). Anti-OmpC was significantly more prevalent among individuals with perianal disease (p, 0.0001). Two statistically significant SNPs were identified. One was a SNP at chromosome 8q24 (rs6470545, p=9x10E-6), which is 200 kilobases upstream from the proto-oncogene MYC, and near a colon cancer locus (rs6983267) known to control MYC expression. Three nearby SNPs (rs10091329, rs6470537, rs6470552) in close linkage disequilibrium (r2 .0.8) had p-values of 10E-5. Another SNP on chromosome 8 in a gene desert was also associated with perianal disease (rs10092418, p=8x10E-6). Conclusions: We report novel genetic and serologic associations with perianal disease in a large cohort of Crohn's disease patients. The association between perianal disease and a locus near MYC, which encodes a transcription factor with broad activity in cell proliferation, apoptosis, and differentiation, suggests novelmechanisms in the development of perianal disease. Replication will be important to confirm findings and direct further investigation into this unique Crohn's disease phenotype. *Dr. Weizman and Dr. Murdoch contributed equally to this study.