Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
J Crohns Colitis. 2019 Apr 26;13(5):600-606. doi: 10.1093/ecco-jcc/jjy210.
Perianal abscess [PA] is associated with inflammatory bowel disease [IBD]. The incidence of IBD after a diagnosis of PA and potential predictors of a future diagnosis of IBD are unknown.
The Health Improvement Network [THIN] is a primary care database representative of the UK population. Incident cases of PA were identified between 1995 and 2017. Subjects with PA were matched to controls within the same general practice. The primary outcome was a subsequent diagnosis of Crohn's Disease [CD] or ulcerative colitis [UC]. A Cox regression model was used to assess potential predictors of a new diagnosis of CD or UC following PA.
The risk of CD was higher in the PA cohort compared with controls; adjusted hazard ratio [HR] 7.51 (95% confidence interval [CI] 4.86-11.62), p < 0.0001. The risk of UC was also higher in the PA cohort compared with controls; adjusted HR 2.03 [1.38-2.99], p < 0.0001. Anaemia in men (HR 2.82 [1.34-5.92], p = 0.002), and use of antidiarrhoeal medications (HR 2.70 [1.71-4.25], p < 0.0001) were associated with an increased risk of CD following PA. Anaemia in men (HR 2.58 [1.09-6.07], p = 0.03), diarrhoea (HR 2.18 [1.23-3.85], p = 0.007), and use of anti-diarrhoeal medication (HR 2.27 [1.19-4.30], p = 0.012) were associated with an increased risk of UC following PA.
Subjects with PA are at an increased risk of subsequent diagnosis of CD and UC. Clinicians should strongly consider investigation for IBD in young patients presenting with diarrhoea and anaemia [in males] following PA. Future research should discern appropriate screening strategies for this high-risk cohort.
肛周脓肿 [PA] 与炎症性肠病 [IBD] 有关。PA 诊断后的 IBD 发病率以及未来 IBD 诊断的潜在预测因素尚不清楚。
健康改进网络 [THIN] 是一个代表英国人口的初级保健数据库。1995 年至 2017 年间，确定了 PA 的发病病例。PA 患者在同一全科医生诊所中与对照组进行匹配。主要结局是随后诊断出克罗恩病 [CD] 或溃疡性结肠炎 [UC]。使用 Cox 回归模型评估 PA 后新诊断为 CD 或 UC 的潜在预测因素。
PA 队列中 CD 的风险高于对照组；调整后的危险比 [HR] 为 7.51（95%置信区间 [CI] 4.86-11.62），p < 0.0001。PA 队列中 UC 的风险也高于对照组；调整后的 HR 为 2.03（1.38-2.99），p < 0.0001。男性贫血（HR 2.82 [1.34-5.92]，p = 0.002）和使用止泻药（HR 2.70 [1.71-4.25]，p < 0.0001）与 PA 后 CD 风险增加相关。男性贫血（HR 2.58 [1.09-6.07]，p = 0.03）、腹泻（HR 2.18 [1.23-3.85]，p = 0.007）和使用止泻药（HR 2.27 [1.19-4.30]，p = 0.012）与 PA 后 UC 风险增加相关。
PA 患者随后诊断出 CD 和 UC 的风险增加。临床医生应强烈考虑对出现腹泻和贫血 [男性] 的年轻 PA 患者进行 IBD 检查。未来的研究应确定针对这一高危人群的适当筛查策略。
