Wallenhorst Timothée, Brochard Charlène, Bretagne Jean-François, Bouguen Guillaume, Siproudhis Laurent
Department of Hepato-Gastroenterology, University Hospital of Rennes, Service des Maladies de l'Appareil Digestif, CHU, Pontchaillou, 2 rue Henri le Guilloux, 35033 Rennes Cedex, France.
INSERM U991, University of Rennes 1, Rennes, France.
Int J Colorectal Dis. 2016 Feb;31(2):307-11. doi: 10.1007/s00384-015-2390-8. Epub 2015 Sep 26.
Perianal Crohn's disease (CD) encompasses a variety of lesion similar to luminal disease, which are usually not distinctly assessed. Links between luminal and perianal CD phenotype remains therefore underreported, and we aimed to describe both luminal and perianal phenotype and their relationships.
From January 2007, clinical data of all consecutive patients with CD seen in a referral center were prospectively recorded. Data recorded until October 2011 were extracted and reviewed for study proposal.
A total of 282 patients (M/F, 108/174; aged 37.8 ± 16.2 years) were assessed that included 154 cases (54.6%) with anal ulceration, 118 cases (41.8%) with fistula, 49 cases (17.4%) with stricture, and 94 cases without anal lesion (33.3%). Anal ulcerations were associated with fistulas (N = 87/154) in more than half of patients (56.5%) and were isolated in 55 patients (35.7%). Most of strictures (94%) were associated with other lesions (N = 46/49). Harvey-Bradshaw score was significantly higher in patients with ulcerations (p < 0.001) as compared to those with perianal fistulas (p = 0.15) or with anal strictures (p = 0.16). Proportions of complicated behavior (fistulizing or stricturing) of luminal CD were similar according to anal lesions: anal fistulas were not significantly associated to penetrating Montreal phenotype (N = 4/31 p = 0.13) as well as anal stricture and stricturing Montreal phenotype (N = 3/49, p = 0.53).
The phenotype of luminal disease does not link with the occurrence and the phenotype of perianal Crohn's disease. Anal ulcerations denote a more severe disease on both luminal and perianal locations and should consequently be taking into account in physician decision-making.
肛周克罗恩病（CD）包含多种与肠腔疾病相似的病变，这些病变通常未得到明确评估。因此，肠腔型和肛周型CD表型之间的联系报道较少，我们旨在描述肠腔型和肛周型表型及其关系。
从2007年1月起，前瞻性记录转诊中心所有连续就诊的CD患者的临床资料。提取并审查截至2011年10月记录的数据以进行研究提案。
共评估了282例患者（男/女，108/174；年龄37.8±16.2岁），其中154例（54.6%）有肛门溃疡，118例（41.8%）有肛瘘，49例（17.4%）有狭窄，94例无肛门病变（33.3%）。超过半数患者（56.5%）的肛门溃疡与肛瘘相关（N = 87/154），55例（35.7%）为孤立性肛门溃疡。大多数狭窄（94%）与其他病变相关（N = 46/49）。与肛周瘘管患者（p = 0.15）或肛门狭窄患者（p = 0.16）相比，溃疡患者的哈维 - 布拉德肖评分显著更高（p < 0.001）。根据肛门病变情况，肠腔型CD复杂行为（瘘管形成或狭窄形成）的比例相似：肛瘘与穿透性蒙特利尔表型无显著相关性（N = 4/31，p = 0.13），肛门狭窄与狭窄性蒙特利尔表型也无显著相关性（N = 3/49，p = 0.53）。
肠腔型疾病的表型与肛周克罗恩病的发生及表型无关。肛门溃疡表明在肠腔和肛周部位疾病更为严重，因此在医生决策时应予以考虑。
