PhD Scientific Days 2024

Poster Session J - Pathological and Oncological Sciences 1.

Burden of perianal disease in Crohn’s disease: accelerating medical therapy and high rates of perianal surgery over the last four decades – results from a population-based study over 4 decades

Text of the abstract

Background: Few population-based studies have investigated prevalence and disease course of perianal manifestation in Crohn’s disease.
Aims: Our aim was to analyze the prevalence and outcomes of perianal Crohn’s disease including medical therapies and need for perianal surgery, over different therapeutic eras based on the time of diagnosis; cohort-A (1977-1995), cohort-B (1996-2008), and cohort-C (2009-2018).
Methods: Patient inclusion lasted between 1977 and 2018. Patients were followed prospectively, both in-hospital and outpatient records were reviewed regularly. Perianal surgical procedure was defined as any perianal incision and excision, fistulotomy, or abscess drainage.
Results: A total of 946 incident patients were included. Perianal disease at diagnosis was present in 17.4% (n=165) of the total cohort, with a declining prevalence in cohorts A/B/C, respectively (24.7% / 18.5% / 13.2%; p=0.001). By the end of the follow-up, an additional 9.3% (n=88) of the total cohort developed perianal disease. Cumulative immunosuppressive and biologic exposure increased over time, and biologic use was higher in patients with perianal disease (pLog Rank<0.001). The overall rate of perianal surgery was 44.7% (113/253), with a probability of 28.3%(95%CI:25.4-31.2) after 10 years, 41.0%(95%CI:37.5-44.5) after 20 years, and 64.1%(95%CI:59-69.2) after 30 years. There was no statistically significant difference in the probability of first perianal surgery between cohorts A/B/C (Log Rank=0.594).
Conclusions: The burden of perianal disease and perianal surgery rates were high in this cohort. Therapeutic strategy was accelerated in patients with perianal Crohn’s over time with higher exposure to immunosuppressives and biologicals. Surgical management of perianal disease remained unchanged compared to earlier cohorts.

Funding
This work was supported by the ÚNKP-23-4-II-SE-20 New National Excellence Program of the Ministry for Culture and Innovation from the Source of the National Research, Development and Innovation Fund.