title: Time Trends, Clinical Characteristics, and Risk Factors of Chronic Anal Fissure Among a National Cohort of Patients with Inflammatory Bowel Disease.
abstract: BACKGROUND
  Chronic anal fissure (CAF) is a common problem that causes significant morbidity. Little is known about the risk factors of CAF among patients with inflammatory bowel disease (IBD).
  
  
  OBJECTIVE
  To study the clinical characteristics and prevalence of CAF among a cohort of IBD patients.
  
  
  METHODS
  We performed a population-based study on IBD patients from the National Veterans Affairs administrative datasets from 1998 to 2011. IBD and AF were identified by ICD-9 diagnosis codes.
  
  
  RESULTS
  We identified 60,376 patients with IBD between the ages of 18-90 years, 94% males, 59% diagnosed with ulcerative colitis (UC), and 88% were Caucasians. The overall prevalence of CAF was 4% for both males and females. African Americans (AA) were two times more likely to have CAF compared to Caucasians (8 vs. 4%; OR 2.0, 95% CI 1.6-20.2, p = 0.0001) or Hispanics (8 vs. 4.8%; OR 2.1, 95% CI 1.4-25.2, p = 0.0001). The prevalence of CAF significantly dropped with age from 7% at age group 20-50 to 1.5% at 60-90 (p = 0.0001). CD patients were two times more likely to have CAF than UC patients (6 vs. 3%; OR 1.9, 95% CI 1.5-18.2, p = 0.0001). The initial diagnosis of CAF occurred within 14 years after the initial diagnosis of IBD in 74.5% patients.
  
  
  CONCLUSIONS
  CAF is more prevalent among IBD than what is reported in the general population and diagnosed after the diagnosis of IBD. CAF is more prevalent among patients with CD, younger patients, and AA. The current results lay the groundwork for further outcome studies relate to anal fissure such as utilization, hospitalization, and cost.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA. hmalaty@bcm.edu.
authors.forename: Hoda M
authors.initials: HM
authors.lastname: Malaty
authors.affiliation: VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Hou
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000453:epidemiology*; D003424:Crohn Disease / Q000453:epidemiology*; D005260:Female; D005401:Fissure in Ano / Q000453:epidemiology* / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Anal fissure; Clinical characteristics; Epidemiology; Extra-intestinal manifestation (EIMs); Inflammatory bowel disease; Risk factors