Perianal Crohn disease (PCD) is a strong predictor of a complicated disease course and requires early intensified treatment, especially in severe perianal disease, according to a study published in Clinical Gastroenterology and Hepatology.

As there exists limited data on perianal involvement in Crohn disease (CD) and comparisons of disease course between severe and non-severe PCD, researchers aimed to explore the disease course of these phenotypes in a population-based study.

Cases were identified from the epidemiology cohort of the Israeli Inflammatory Bowel Disease Research Nucleus database and included 2 Israeli Health Maintenance Organizations which cover 78% of the population. The researchers developed specific algorithms to identify fistulizing PCD and to differentiate severe from non-severe disease by type of medication utilization, ICD-9 codes, and perianal procedures.

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A total of 12,904 patients were diagnosed with CD since 2005 (2186 [17%] pediatric-onset), consisting of 86,119 person-years of follow-up. Fistulizing PCD was diagnosed in 1530 patients (12%) and 574 patients (4%) had severe PCD. The prevalence of perianal involvement was higher in men (15%) than women (9%).

The occurrence 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, patients with PCD 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 worse outcomes compared with non-severe PCD, as exhibited in rates of hospitalizations (61% in non-severe PCD vs 73% in severe; P =.004) and surgeries (35% vs 43%; P =.001).

This study was limited by a lack of available data on disease extent and smoking status among the patient cohort.

“In conclusion, patients with PCD have poorer outcomes compared with those without PCD, especially in severe PCD,” stated the authors. They added, “Our data should be considered in clinical decision making of selecting the most appropriate patients for early intensified medical treatment as well as for cancer surveillance.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Atia O, Asayag N, Focht G, et al. Perianal Crohn’s disease is associated with poor disease outcome: a nation-wide study from the epiIIRN cohort. Clin Gastroenterol Hepatol. Published online April 8, 2021. doi: 10.1016/j.cgh.2021.04.007

This article originally appeared on Gastroenterology Advisor