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Multicenter Study
. 2025 Mar 5;19(3):jjae146.
doi: 10.1093/ecco-jcc/jjae146.

Prolonged Time to Diagnosis of Crohn's Disease in Patients With Perianal Fistulas Negatively Affects Long-Term Outcomes

Liesbeth Jozefien Munster  1   2 , Aagje Johanna Martina Pronk  2 , Marco William Mundt  3 , Roel Hompes  2 , Willem Adrianus Bemelman  2 , Jarmila Dagmara Wendelien van der Bilt  1   2 , Christianne Johanna Buskens  3
Affiliations
Multicenter Study

Prolonged Time to Diagnosis of Crohn's Disease in Patients With Perianal Fistulas Negatively Affects Long-Term Outcomes

Liesbeth Jozefien Munster et al. J Crohns Colitis. .

Abstract

Background and aim: This study aims to evaluate the effect of time to Crohn's disease (CD) diagnosis on perianal fistula (PAF) outcomes in patients with a fistula as the first manifesting sign.

Methods: In this multicenter, retrospective study, CD patients with a PAF preceding CD diagnosis between November 2015 and June 2022 were included. The primary outcome parameter was the time to CD diagnosis and its correlation with long-term outcomes.

Results: In total, 126 patients with a PAF prior to CD diagnosis were identified. The median time to CD diagnosis was 15.0 months (IQR 3.8-47.3). A total of 49 patients (38.9%) had a clinically closed fistula of which 21 patients (42.9%) achieved radiological healing. Twenty-five patients (19.8%) underwent defunctioning, of which 9 patients (36.0%) needed proctectomy. Median time to CD diagnosis was shortest in patients with radiological healing (4.0 months, IQR 2.0-16.5) or clinical closure without radiological healing (11.0 months, IQR 3.0-47.8). In patients without fistula closure (n = 51), the median time to CD diagnosis was significantly longer compared to patients with fistula closure, 18.0 months vs 8.0 months (p = 0.031). In patients who needed defunctioning, the median time to diagnosis was more than twice as long compared to patients without defunctioning, 30.0 months vs 12.0 months (p = 0.054).

Conclusion: A prolonged time to CD diagnosis in patients with a PAF as a manifesting sign is associated with worse long-term outcomes. Patients in whom radiological healing could be achieved had the shortest time to CD diagnosis, emphasizing the relevance of increased clinical awareness of underlying CD in fistula patients.

Keywords: Crohn’s disease; perianal fistula; prolonged time to diagnosis.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Flow diagram of all in-/excluded patients.
Figure 2
Figure 2
Median time to CD diagnosis for different outcomes. Abbreviation: CD, Crohn’s disease.
See this image and copyright information in PMC

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