Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
Maccabi Health Services, Tel-Aviv, and the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):e484-e495. doi: 10.1016/j.cgh.2021.04.007. Epub 2021 Apr 9.
BACKGROUND & AIMS: Limited population-based data have explored perianal involvement in Crohn's disease (CD) and compared the disease course between severe and non-severe perianal CD (PCD). We aimed to explore the disease course of these phenotypes in a population-based study of CD.
Cases were identified from the epi-IIRN cohort and included 2 Israeli health maintenance organizations covering 78% of the population. We validated specific algorithms to identify fistulizing PCD and to differentiate severe from non-severe disease by medication utilization, International Classification of Disease, 9th Revision codes, and perianal procedures.
A total of 12,904 CD patients were included in an inception cohort from 2005 (2186 pediatric-onset, 17%) providing 86,119 person-years of follow-up. Fistulizing PCD was diagnosed in 1530 patients (12%) (574 with severe PCD, 4%). The prevalence of PCD was 7.9%, 9.4%, 10.3%, and 11.6% at 1, 3, 5, and 10 years from CD diagnosis, respectively. At 5 years, PCD patients were more likely to be hospitalized (36% in non-PCD vs 64% in PCD; P < .001), undergo inflammatory bowel disease-related surgeries (9% vs 38%, respectively; P < .001), and develop anorectal cancer (1.2/10,000 person-years for non-PCD vs 4.2/10,000 for PCD; P = .01). Severe PCD was associated with poorer outcomes compared with non-severe PCD, as shown for hospitalizations (61% in non-severe PCD vs 73% in severe; P = .004) and surgeries (35% vs 43%; P = .001).
Despite higher utilization of immunomodulators and biologics, PCD is associated with poor disease outcomes, especially in severe PCD.
有限的基于人群的数据探讨了克罗恩病（CD）的肛周累及，并比较了重度和非重度肛周 CD（PCD）的疾病进程。我们旨在通过一项基于人群的 CD 研究来探讨这些表型的疾病进程。
病例从 epi-IIRN 队列中确定，包括覆盖 78%人口的 2 个以色列健康维护组织。我们通过药物使用、国际疾病分类第 9 版代码和肛周手术验证了特定算法，以识别瘘管性 PCD 并区分重度和非重度疾病。
共有 12904 例 CD 患者纳入 2005 年的起始队列，提供了 86119 人年的随访。共诊断出 1530 例瘘管性 PCD 患者（12%）（574 例重度 PCD，4%）。在从 CD 诊断开始的 1、3、5 和 10 年内，PCD 的患病率分别为 7.9%、9.4%、10.3%和 11.6%。在 5 年内，PCD 患者更有可能住院（非 PCD 患者为 36%，PCD 患者为 64%；P<.001），接受与炎症性肠病相关的手术（分别为 9%和 38%；P<.001），以及发展为肛门直肠癌（非 PCD 患者为 1.2/10000 人年，PCD 患者为 4.2/10000 人年；P=.01）。重度 PCD 与非重度 PCD 相比，预后较差，表现在住院（非重度 PCD 患者为 61%，重度 PCD 患者为 73%；P=.004）和手术（35%对 43%；P=.001）方面。
尽管免疫调节剂和生物制剂的使用率较高，但 PCD 与不良疾病结局相关，尤其是在重度 PCD 中。
