Course and treatment of perianal disease in children newly diagnosed with Crohn's disease.
BACKGROUND
We sought to characterize perianal disease and its treatment in pediatric patients newly diagnosed with Crohn's disease.


METHODS
Data were obtained from the Pediatric Inflammatory Bowel Disease (IBD) Collaborative Group Registry, a prospective, multicenter observational registry recording clinical and laboratory outcomes in children under 16 years of age newly diagnosed with IBD. Patients with Crohn's disease were selected who had data on perianal disease and at least 24 months of follow-up. The records of patients with a Pediatric Crohn's Disease Activity Index perianal subscore greater than 0 were reviewed, and patients with abscesses or fistulas were selected. The therapies used and the course of their perianal disease were then assessed.


RESULTS
Of the 276 patients identified, 41 had perianal lesions within 30 days of diagnosis. Thirteen of these had skin tags and fissures only, whereas 28 had fistulas and/or abscesses. The latter lesions resolved by 1 year in 20 patients, and 8 had chronic/recurrent perianal disease persisting for more than 1 year following diagnosis. Patients with fistulizing disease were much more likely to be treated and were treated earlier with antibiotics, infliximab, and immunomodulators than were nonfistulizing patients. Patients who developed chronic perianal disease were more likely to have low body mass indices and required more perianal surgery than did patients whose perianal disease resolved.


CONCLUSIONS
Approximately 10% of newly diagnosed pediatric patients with Crohn's disease will have perianal fistulas and/or abscesses at the time of diagnosis. Most of these will resolve within a year with medical therapy alone.
Keljo
David J
DJ
Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15213, USA. david.keljo@chp.edu
Markowitz
James
J
Langton
Christine
C
Lerer
Trudy
T
Bousvaros
Athos
A
Carvalho
Ryan
R
Crandall
Wallace
W
Evans
Jonathan
J
Griffiths
Anne
A
Kay
Marsha
M
Kugathasan
Subra
S
LeLeiko
Neal
N
Mack
David
D
Mamula
Petar
P
Moyer
M Susan
MS
Oliva-Hemker
Maria
M
Otley
Anthony
A
Pfefferkorn
Marian
M
Rosh
Joel
J
Hyams
Jeffrey S
JS
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001004:Anus Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents