title: Course and treatment of perianal disease in children newly diagnosed with Crohn's disease.
abstract: 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.
authors.affiliation: Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15213, USA. david.keljo@chp.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Keljo
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Christine
authors.initials: C
authors.lastname: Langton
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Ryan
authors.initials: R
authors.lastname: Carvalho
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: Marsha
authors.initials: M
authors.lastname: Kay
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Neal
authors.initials: N
authors.lastname: LeLeiko
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Petar
authors.initials: P
authors.lastname: Mamula
authors.forename: M Susan
authors.initials: MS
authors.lastname: Moyer
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Marian
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hyams
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents