Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea: Results from the CONNECT study

Jaeyoung Chun, Jong Pil Im, Ji Won Kim, Kook Lae Lee, Chang Hwan Choi, Hyunsoo Kim, Jae Hee Cheon, Byong Duk Ye, Young Ho Kim, You Sun Kim, Yoon Tae Jeen, Dong Soo Han, Won Ho Kim, Joo Sung Kim

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Abstract

Background/Aims: The disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population. Methods: The retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for <12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses. Results: The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses. Conclusions: Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.

Original languageEnglish
Pages (from-to)544-554
Number of pages11
JournalGut and liver
Volume12
Issue number5
DOIs
Publication statusPublished - 2018 Sep

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All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Chun, J., Im, J. P., Kim, J. W., Lee, K. L., Choi, C. H., Kim, H., Cheon, J. H., Ye, B. D., Kim, Y. H., Kim, Y. S., Jeen, Y. T., Han, D. S., Kim, W. H., & Kim, J. S. (2018). Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea: Results from the CONNECT study. Gut and liver, 12(5), 544-554. https://doi.org/10.5009/gnl18157