title: Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection.
abstract: OBJECTIVE
  The presence of perianal disease in Crohn's disease patients is one of the factors of postoperative recurrence. The aim of this study is to evaluate long-term prognosis of perianal Crohn's disease patients in Asian.
  
  
  METHODS
  Patients with Crohn's disease who had undergone surgical bowel resection were divided into two groups according to the presence of perianal lesion. We monitored the occurrences of abdominal and/or perianal reoperation and readmission due to disease flare-up.
  
  
  RESULTS
  The 132 patients included in the study were divided into 2 groups, those with perianal disease (45 patients, 34.1%) and those without perianal disease (87 patients, 65.9%). Patients with perianal disease was younger in age (33.8 years versus 39.8 years, p = 0.015) and had been diagnosed as CD at a younger age (21.9 years versus 28.6 years, p = 0.005) than patients without perianal disease. Patients with perianal disease showed more extra-intestinal manifestation than patients without perianal disease (8 versus 3, p = 0.008). Reoperation was required in 46 (44.8%) patients during the follow-up period. The presence of perianal disease independently increased the risk of reoperation [hazard ratio (HR), 3.112; confidence interval (CI), 1.707-5.675]. Furthermore, patients with perianal disease had increasing risks of abdominal reoperation (HR 1.978; 95% CI, 1.034-3.784).
  
  
  CONCLUSIONS
  Patients with Crohn's disease and perianal lesions had a higher risk of reoperation. Considering these findings, physicians should consider aggressive and early top down therapy for patients with perianal Crohn's disease.
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Yoo Min
authors: YM
authors: Han
authors: Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Ji Won
authors: JW
authors: Kim
authors: Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Seong-Joon
authors: SJ
authors: Koh
authors: Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Byeong Gwan
authors: BG
authors: Kim
authors: Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Kook Lae
authors: KL
authors: Lee
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Jong Pil
authors: JP
authors: Im
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Joo Sung
authors: JS
authors: Kim
authors: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors: Hyun Chae
authors: HC
authors: Jung
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000601:surgery; D000328:Adult; D044466:Asian People; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D018450:Disease Progression; D004322:Drainage; D005260:Female; D005401:Fissure in Ano / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012003:Rectal Fistula / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D066106:Seoul / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: crohn disease; inflammatory bowel diseases; perianal disease; prognosis; reoperation