Munster L J, Meriba G R, Schuitema J, van Dieren S, de Groof E J, Mundt M W, D'Haens G R, Bemelman W A, Buskens C J, van der Bilt J D W
Department of Surgery, Flevoziekenhuis, Almere, The Netherlands.
Department of Surgery, Amsterdam UMC (Location VUmc), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Tech Coloproctol. 2025 Mar 28;29(1):89. doi: 10.1007/s10151-024-03106-y.
Delay in diagnosing Crohn's disease (CD) in patients presenting with perianal abscess (PAA) and/or fistula (PAF) is common. The aim of this study was to identify red flags suggestive of CD.
A systematic literature review was conducted to identify symptoms associated with CD in patients presenting with PAA/PAF. A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012-2023) at a single non-academic teaching hospital. All patients were asked to recall symptoms/signs experienced during their first PAF.
The systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (n = 2)/PAF (n = 6), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72-0.94]).
The perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.
肛周脓肿（PAA）和/或肛瘘（PAF）患者中克罗恩病（CD）的诊断延迟很常见。本研究的目的是确定提示CD的危险信号。
进行系统的文献综述，以确定PAA/PAF患者中与CD相关的症状。向所有患有PAF并最终被诊断为CD的成年患者以及同一研究期间来自同一非学术教学医院的隐窝腺性PAF匹配患者（1:3）发放一份包含这些症状的问卷，并补充了来自国际炎症性肠病研究组织（IO-IBD）腔内CD危险信号指数的项目。所有患者均被要求回忆首次出现PAF时经历的症状/体征。
系统综述确定了8篇报告，涉及PAA患者（n = 2）/PAF患者（n = 6）的15项临床特征，并补充了IO-IBD危险信号指数的13项（共28项）。共有25例CD患者和75例无CD的PAF患者回答了问卷。单因素分析确定了7项与CD相关的项目（年龄、家族史、>2次肛周干预、体重减轻、腹痛、腹泻和疲劳），多因素分析中有4项仍然显著：年龄（OR 3.4 [1.0 - 11.5]）、>2次既往肛周干预（OR 3.4 [1.0 - 10.1]）、体重减轻（OR 14.4 [3.7 - 55.6]）和腹痛（OR 9.8 [1.9 - 49.8]）。受试者操作特征曲线（ROC）分析表明，这些危险信号的组合与CD和非CD的良好鉴别相关（AUC 0.83 [0.72 - 0.94]）。
肛周危险信号指数对早期识别有潜在CD风险的PAF患者具有良好的预测价值。
