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Meta-Analysis
. 2022 Oct 3;28(10):1477-1484.
doi: 10.1093/ibd/izab287.

Epidemiology and Natural History of Perianal Crohn's Disease: A Systematic Review and Meta-Analysis of Population-Based Cohorts

Lester Tsai  1 , Jeffrey D McCurdy  2   3 , Christopher Ma  4 , Vipul Jairath  5   6 , Siddharth Singh  1   7
Affiliations
Meta-Analysis

Epidemiology and Natural History of Perianal Crohn's Disease: A Systematic Review and Meta-Analysis of Population-Based Cohorts

Lester Tsai et al. Inflamm Bowel Dis. .

Abstract

Background and aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Montreal classification; anti-TNF; epidemiology; fistula; natural history.

Plain language summary

In a systematic review and meta-analysis of 12 population-based cohort studies, we observed that approximately 1 in 5 patients develops perianal disease within 10 years of Crohn’s disease diagnosis. Of these, two-thirds require perianal surgery and 6% require major abdominal surgery.

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Conflict of interest statement

L.T.: none to declare. J.D.M.: consulting fees from Janssen, AbbVie, Takeda, and Pfizer. C.M.: consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, Bristol Myers Squibb, Ferring, Fresenius Kabi, Janssen, McKesson, Mylan, Takeda, Pfizer, and Roche; speaker fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Janssen, Takeda, and Pfizer; and research support from Pfizer. V.J.: consulting/advisory board fees from AbbVie, Alimentiv Inc (formerly Robarts Clinical Trials), Arena Pharmaceuticals, Asieris, Bristol Myers Squibb, Celltrion, Eli Lilly, Ferring, Fresenius Kabi, Galapagos, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, Mylan, Pandion, Pendopharm, Pfizer, Reistone Biopharma, Roche, Sandoz, Takeda, Teva, and Topivert; and speaker fees from, AbbVie, Ferring, Galapagos, Janssen Pfizer Shire, and Takeda. S.S.: research grants from AbbVie and Janssen.

Figures

Figure 1.
Figure 1.
Study selection flowsheet. CD, Crohn’s disease; IBD, inflammatory bowel disease.
Figure 2.
Figure 2.
Overall prevalence of perianal Crohn’s disease (CD) in population-based cohorts. CI, confidence interval.
Figure 3.
Figure 3.
Cumulative 1-, 5- and 10-year risk of developing perianal disease in patients with Crohn’s disease (CD). CI, confidence interval; pCD, perianal Crohn’s disease.
Figure 4.
Figure 4.
Risk of minor perianal surgery (including incision and drainage, examination under anesthesia, seton placement, fistulotomy, advanced local surgical procedures) in patients with perianal Crohn’s disease (CD). CI, confidence interval.
Figure 5.
Figure 5.
Risk of major abdominal surgery (including bowel resection, defunctioning surgery such as ileostomy or colostomy, proctectomy) in patients with perianal Crohn’s disease (CD). CI, confidence interval.
See this image and copyright information in PMC

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