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, JaeHee Cheon, Byong Duk Ye, Young Ho Kim, You Sun Kim, Yoon Tae Jeen, Dong Soo Han, Won Ho Kim, Joo Sung Kim

Research output: Contribution to journalArticle

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 1

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Korea
Crohn Disease
Fistula
Cohort Studies
Abdominal Abscess
Clinical Studies
Pathologic Constriction
Abscess
Primary Health Care
Referral and Consultation

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Chun, Jaeyoung ; Im, Jong Pil ; Kim, Ji Won ; Lee, Kook Lae ; Choi, Chang Hwan ; Kim, Hyunsoo ; Cheon, JaeHee ; Ye, Byong Duk ; Kim, Young Ho ; Kim, You Sun ; Jeen, Yoon Tae ; Han, Dong Soo ; Kim, Won Ho ; Kim, Joo Sung. / Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea : Results from the CONNECT study. In: Gut and liver. 2018 ; Vol. 12, No. 5. pp. 544-554.
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title = "Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea: Results from the CONNECT study",
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.",
author = "Jaeyoung Chun and Im, {Jong Pil} and Kim, {Ji Won} and Lee, {Kook Lae} and Choi, {Chang Hwan} and Hyunsoo Kim and JaeHee Cheon and Ye, {Byong Duk} and Kim, {Young Ho} and Kim, {You Sun} and Jeen, {Yoon Tae} and Han, {Dong Soo} and Kim, {Won Ho} and Kim, {Joo Sung}",
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Chun, J, Im, JP, Kim, JW, Lee, KL, Choi, CH, Kim, H, Cheon, J, Ye, BD, Kim, YH, Kim, YS, Jeen, YT, Han, DS, Kim, WH & Kim, JS 2018, 'Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea: Results from the CONNECT study', Gut and liver, vol. 12, no. 5, pp. 544-554. https://doi.org/10.5009/gnl18157

Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea : Results from the CONNECT study. / Chun, Jaeyoung; Im, Jong Pil; Kim, Ji Won; Lee, Kook Lae; Choi, Chang Hwan; Kim, Hyunsoo; Cheon, JaeHee; Ye, Byong Duk; Kim, Young Ho; Kim, You Sun; Jeen, Yoon Tae; Han, Dong Soo; Kim, Won Ho; Kim, Joo Sung.

In: Gut and liver, Vol. 12, No. 5, 01.09.2018, p. 544-554.

Research output: Contribution to journalArticle

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T1 - Association of perianal fistulas with clinical features and prognosis of Crohn’s disease in Korea

T2 - Results from the CONNECT study

AU - Chun, Jaeyoung

AU - Im, Jong Pil

AU - Kim, Ji Won

AU - Lee, Kook Lae

AU - Choi, Chang Hwan

AU - Kim, Hyunsoo

AU - Cheon, JaeHee

AU - Ye, Byong Duk

AU - Kim, Young Ho

AU - Kim, You Sun

AU - Jeen, Yoon Tae

AU - Han, Dong Soo

AU - Kim, Won Ho

AU - Kim, Joo Sung

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

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