title: Time trends in the epidemiology and outcome of perianal fistulizing Crohn's disease in a population-based cohort.
abstract: OBJECTIVE
  Perianal disease is a debilitating condition that frequently occurs in Crohn's disease (CD) patients. It is currently unknown whether its incidence has changed in the era of frequent immunomodulator use and biological availability. We studied the incidence and outcome of perianal and rectovaginal fistulas over the past two decades in our population-based Inflammatory Bowel Disease South-Limburg cohort.
  
  
  METHODS
  All 1162 CD patients registered in the Inflammatory Bowel Disease South-Limburg registry were included. The cumulative probabilities of developing a perianal and rectovaginal fistula were compared between three eras distinguished by the year of CD diagnosis: 1991-1998, 1999-2005 and 2006-2011. Second, clinical risk factors and the risk of fistula recurrence were determined.
  
  
  RESULTS
  The cumulative 5-year perianal fistula rate was 14.1% in the 1991-1998 era, 10.4% in the 1999-2005 era and 10.3% in the 2006-2011 era, P=0.70. Colonic disease was associated with an increased risk of developing perianal disease, whereas older age was associated with a decreased risk (both P<0.01). Over time, more patients were exposed to immunomodulators or biologicals before fistula diagnosis (18.5 vs. 32.1 vs. 52.1%, respectively, P=0.02) and started biological therapy thereafter (18.6 vs. 34.1 vs. 54.0%, respectively, P<0.01). The cumulative 5-year perianal fistula recurrence rate was not significantly different between eras (19.5 vs. 25.5 vs. 33.1%, P=0.28). In contrast, the cumulative 5-year rectovaginal rate attenuated from 5.7% (the 1991-2005 era) to 1.7% (the 2006-2011 era), P=0.01.
  
  
  CONCLUSIONS
  Over the past two decades, the risk of developing a perianal fistula was stable, as well as its recurrence rate, underlining the lasting need for improving treatment strategies for this invalidating condition.
authors.affiliation: Departments of aGeneral Surgery bInternal Medicine, Division of Gastroenterology-Hepatology cSchool of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht dDepartment of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Centre, Sittard-Geleen eDepartment of Internal Medicine and Gastroenterology-Hepatology, Zuyderland Medical Centre, Heerlen, The Netherlands.
authors.forename: Kevin W A
authors.initials: KW
authors.lastname: Göttgens
authors.forename: Steven F G
authors.initials: SF
authors.lastname: Jeuring
authors.forename: Rosel
authors.initials: R
authors.lastname: Sturkenboom
authors.forename: Mariëlle J L
authors.initials: MJ
authors.lastname: Romberg-Camps
authors.forename: Liekele E
authors.initials: LE
authors.lastname: Oostenbrug
authors.forename: Daisy M A E
authors.initials: DM
authors.lastname: Jonkers
authors.forename: Laurents P S
authors.initials: LP
authors.lastname: Stassen
authors.forename: Ad A M
authors.initials: AA
authors.lastname: Masclee
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Pierik
authors.forename: Stéphanie O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D000328:Adult; D001691:Biological Therapy / Q000379:methods / Q000639:trends; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012003:Rectal Fistula / Q000453:epidemiology* / Q000209:etiology*; D012006:Rectovaginal Fistula / Q000453:epidemiology / Q000209:etiology; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D007155:Immunologic Factors