James Markowitz, MD, has served as a consultant for, received research support from, and served on the speakers' bureau of Centocor, research support from Astra Zeneca, and served as a consultant and received research support from Abbott
Course and treatment of perianal disease in children newly diagnosed with Crohn's disease
Version of Record online: 20 NOV 2008
Copyright © 2008 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 15, Issue 3, pages 383–387, March 2009
How to Cite
Keljo, D. J., Markowitz, J., Langton, C., Lerer, T., Bousvaros, A., Carvalho, R., Crandall, W., Evans, J., Griffiths, A., Kay, M., Kugathasan, S., LeLeiko, N., Mack, D., Mamula, P., Moyer, M. S., Oliva-Hemker, M., Otley, A., Pfefferkorn, M., Rosh, J. and Hyams, J. S. (2009), Course and treatment of perianal disease in children newly diagnosed with Crohn's disease. Inflamm Bowel Dis, 15: 383–387. doi: 10.1002/ibd.20767
- Issue online: 9 FEB 2009
- Version of Record online: 20 NOV 2008
- Manuscript Accepted: 21 AUG 2008
- Manuscript Received: 17 AUG 2008
- Centocor, Inc., Horsham, Pennsylania
- Astra Zeneca, Wilmington, Delaware
- Reach Out for Youth with Ileitis and Colitis, Melville, New York
- collaborating institutions
- rectal fistula;
- anus disease;
- Crohn's disease;
Background: We sought to characterize perianal disease and its treatment in pediatric patients newly diagnosed with Crohn's disease.
Methods: Data were obtained from the Pediatric Inflammatory Bowel Disease (IBD) Collaborative Group Registry, a prospective, multicenter observational registry recording clinical and laboratory outcomes in children under 16 years of age newly diagnosed with IBD. Patients with Crohn's disease were selected who had data on perianal disease and at least 24 months of follow-up. The records of patients with a Pediatric Crohn's Disease Activity Index perianal subscore greater than 0 were reviewed, and patients with abscesses or fistulas were selected. The therapies used and the course of their perianal disease were then assessed.
Results: Of the 276 patients identified, 41 had perianal lesions within 30 days of diagnosis. Thirteen of these had skin tags and fissures only, whereas 28 had fistulas and/or abscesses. The latter lesions resolved by 1 year in 20 patients, and 8 had chronic/recurrent perianal disease persisting for more than 1 year following diagnosis. Patients with fistulizing disease were much more likely to be treated and were treated earlier with antibiotics, infliximab, and immunomodulators than were nonfistulizing patients. Patients who developed chronic perianal disease were more likely to have low body mass indices and required more perianal surgery than did patients whose perianal disease resolved.
Conclusions: Approximately 10% of newly diagnosed pediatric patients with Crohn's disease will have perianal fistulas and/or abscesses at the time of diagnosis. Most of these will resolve within a year with medical therapy alone.
(Inflamm Bowel Dis 2008)