Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Inflamm Bowel Dis. 2022 Oct 3;28(10):1477-1484. doi: 10.1093/ibd/izab287.
Perianal Crohn's disease (pCD) is a potentially severe phenotype of CD. We conducted a systematic review with meta-analysis to estimate cumulative incidence, risk factors, and outcomes of pCD in population-based cohort studies.
Through a systematic literature review through March 1, 2021, we identified population-based inception cohort studies reporting cumulative incidence of perianal disease (primarily abscess and/or fistula) in patients with CD. We estimated the cumulative incidence of pCD at presentation and 1-, 5-, and 10-year follow-up, and risk factors for perianal disease and outcomes including risk of major (bowel resection, proctectomy, ostomy) and minor perianal (incision and drainage, seton placement, etc.) surgery.
In 12 population-based studies, prevalence of pCD was 18.7% (95% confidence interval [CI], 12.5%-27.0%) with 1-, 5-, and 10-year risk of perianal disease being 14.3% (95% CI, 7.9%-24.6%), 17.6% (95% CI, 11.3%-26.5%), and 18.9% (95% CI, 15.0%-23.4%), respectively. Approximately 11.5% of patients (95% CI, 6.7%-19.0%) had perianal disease at or before CD diagnosis. Colonic disease location and rectal involvement were associated with higher risk of pCD. Overall, 63.3% of patients (95% CI, 53.3-72.3) required minor perianal surgery and 6.4% of patients (95% CI, 1.8%-20.6%) required major abdominal surgery for pCD. Use of biologic therapy for pCD is common and has steadily increased throughout the years.
Approximately 1 in 5 patients with CD develops perianal disease within 10 years of CD diagnosis, including 11.5% who have perianal disease at presentation. Approximately two-thirds of patients require perianal surgery, with a smaller fraction requiring major abdominal surgery.
肛周克罗恩病（pCD）是一种潜在严重的克罗恩病表型。我们进行了一项系统综述和荟萃分析，以估计人群队列研究中 pCD 的累积发病率、危险因素和结局。
通过系统文献综述，我们在 2021 年 3 月 1 日之前确定了报告 CD 患者肛周疾病（主要为脓肿和/或瘘管）累积发病率的基于人群的起始队列研究。我们估计了 pCD 在就诊时以及 1、5 和 10 年随访时的累积发病率，以及肛周疾病的危险因素和结局，包括主要（肠切除术、直肠切除术、造口术）和次要（切开引流术、挂线术等）肛周手术的风险。
在 12 项基于人群的研究中，pCD 的患病率为 18.7%（95%置信区间[CI]，12.5%-27.0%），1、5 和 10 年肛周疾病的风险分别为 14.3%（95%CI，7.9%-24.6%）、17.6%（95%CI，11.3%-26.5%）和 18.9%（95%CI，15.0%-23.4%）。约 11.5%的患者（95%CI，6.7%-19.0%）在 CD 诊断时或之前就有肛周疾病。结肠疾病位置和直肠受累与 pCD 的高风险相关。总体而言，63.3%的患者（95%CI，53.3%-72.3%）需要接受次要肛周手术，6.4%的患者（95%CI，1.8%-20.6%）需要接受主要腹部手术治疗 pCD。生物治疗在 pCD 中的应用很常见，并且多年来一直在稳步增加。
约 1/5 的 CD 患者在 CD 诊断后 10 年内会发生肛周疾病，其中 11.5%在就诊时就有肛周疾病。约 2/3 的患者需要接受肛周手术，其中较小比例的患者需要接受主要腹部手术。
