Analysis of the clinical characteristics of 139 patients with Crohn’s disease combined withperianal fistula in a single center_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Minmin ¹ , ZHU Ping ² , WANG Hao ¹ , CHEN Hongjin ² ,  GU Yunfei ² ,  ZENG Li ²

1. Department of Colorectal Surgery, The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210029, P. R. China;
2. The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China;

Corresponding?author：

GU Yunfei, Email: Guyunfei127@126.com; ZENG Li, Email: zengbingli@163.com

Keywords：

Crohn’s disease; perianal fistula; clinical characteristic

DOI：

10.7507/1007-9424.201806034

Video：

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Objective To explore the clinical characteristics of Crohn’s disease (CD) with perianal fistula by analyzing the clinical data of them. Methods A total of 139 cases of CD with perianal fistula who got treatment from January 2010 to January 2017 in The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were analyzed retrospectively. Results The proportion of males and females in 139 patients was about 3.3∶1.0, the age was (28±8) years, and 47.5% of patients had perianal fistula before CD diagnosis. The percents of patients with perianal surgery history and medication history were 64.7% and 74.1%, respectively. The ratio of L3 type (diseased position) was 49.6%. The ratios of inflammatory type (B1 type) and stenotic type (B2 type) of the disease were 51.8% and 41.0%, respectively. The complex perianal fistula accounted for 90.6%, and 31.7% of patients combined analrectal stricture. Symptoms of diarrhea were found in 46.0% of patients and perianal lesions alone in 29.5% of patients; 54.0% of patients combined with abnormal BMI; 64.7% of patients were in the active stage of Crohn’s disease activity index (CDAI) and 94.2 % of patients were in the active period of perianal disease activity index (PDAI). The patients with erythrocyte sedimentation rate (ESR) higher than normal were 53.2%. The results of logistic showed that, age and degree of CDAI were influencing factors for CD with stenosis of perianal fistula. Conclusions Characteristics of patients with CD combined with perianal fistula include: young, men predominant, high prevalence of ileocolic position involvement, as well as inflammation and stenosis disease behavior. Fistula symptoms often preced the intestinal symptoms and diarrhea is the most common intestinal performance. History of perianal abscess and fistula operation are common. The anorectal stricture are complicated usually. Intestinal inflammation is active. Some patients show abnormal laboratory indicators of inflammation. This suggests that patients with perianal fistula with these clinical features should be alert to the possibility of CD, so as toavoid the consequences of blind surgery. The higher CDAI score and the older the diagnosis age, the higher the risk ofrectal stenosis.

Citation： XU Minmin, ZHU Ping, WANG Hao, CHEN Hongjin, GU Yunfei, ZENG Li. Analysis of the clinical characteristics of 139 patients with Crohn’s disease combined withperianal fistula in a single center. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(10): 1176-1182. doi: 10.7507/1007-9424.201806034 Copy

1.	Rozpondek P, Zwolińska-Wcis?o M, Przybylska M, et al. Effectiveness of anti-TNF alpha antibodies in treatment of fistulizing Crohn’s disease. Przegl Lek, 2011, 68(9): 602-605.
2.	Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut, 2006, 55(Suppl 1): i36-i58.
3.	竺平, 陳玉根, 谷云飛, 等. 單中心肛周克羅恩病臨床特點分析. 中華胃腸外科雜志, 2016, 19(12): 1384-1388.
4.	中華醫學會消化病學分會炎癥性腸病學組. 炎癥性腸病營養支持治療專家共識(2013 · 深圳). 中華內科雜志, 2013, 52(12): 1082-1087.
5.	Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol, 2005, 19 Suppl A: 5A-36A.
6.	Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology, 1976, 70(3): 439-444.
7.	Irvine EJ. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol, 1995, 20(1): 27-32.
8.	American Gastroenterological Association Clinical Practice Committee. American Gastroenterological Association medical position statement: perianal Crohn’s disease. Gastroenterology, 2003, 125(5): 1503-1507.
9.	Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North America, 2002, 31(1): 1-20.
10.	李冠煒, 任建安. 重視我國克羅恩病流行病學的研究. 腸外與腸內營養, 2017, 24(3): 135-137.
11.	Song XM, Gao X, Li MZ, et al. Clinical features and risk factors for primary surgery in 205 patients with Crohn’s disease: analysis of a South China cohort. Dis Colon Rectum, 2011, 54(9): 1147-1154.
12.	Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel disease. Clin Epidemiol, 2013, 5: 237-247.
13.	Zeng Z, Zhu Z, Yang Y, et al. Incidence and clinical characteristics of inflammatory bowel disease in a developed region of Guangdong Province, China: a prospective population-based study. J Gastroenterol Hepatol, 2013, 28(7): 1148-1153.
14.	Zhao J, Ng SC, Lei Y, et al. First prospective, population-based inflammatory bowel disease incidence study in mainland of China: the emergence of " western” disease. Inflamm Bowel Dis, 2013, 19(9): 1839-1845.
15.	Ng SC, Leung WK, Shi HY, et al. Epidemiology of inflammatory bowel disease from 1981 to 2014: results from a territory-wide population-based registry in Hong Kong. Inflamm Bowel Dis, 2016, 22(8): 1954-1960.
16.	Kuo CJ, Yu KH, See LC, et al. The trend of inflammatory bowel diseases in Taiwan: a population-based study. Dig Dis Sci, 2015, 60(8): 2454-2462.
17.	Gomollón F, Dignass A, Annese V, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis, 2017, 11(1): 3-25.
18.	Gionchetti P, Dignass A, Danese S, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
19.	楊柏霖, 竺平, 孫桂東. 克羅恩病肛瘺的診斷與治療. 世界華人消化雜志, 2009, 17(20): 2058-2063.
20.	Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut, 2014, 63(9): 1381-1392.
21.	Siegmund B, Feakins RM, Barmias G, et al. Results of the fifth scientific workshop of the ECCO (Ⅱ): pathophysiology of perianal fistulizing disease. J Crohns Colitis, 2016, 10(4): 377-386.
22.	Kalluri R, Neilson EG. Epithelial-mesenchymal transition and its implications for fibrosis. J Clin Invest, 2003, 112(12): 1776-1784.
23.	Scharl M, Huber N, Lang S, et al. Hallmarks of epithelial to mesenchymal transition are detectable in Crohn’s disease associated intestinal fibrosis. Clin Transl Med, 2015, 4: 1.
24.	Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology, 2008, 135(4): 1106-1113.
25.	Louis E, Collard A, Oger AF, et al. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut, 2001, 49(6): 777-782.
26.	Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med, 2001, 135(10): 906-918.
27.	袁柏思, 金鑫鑫, 路又可, 等. 克羅恩病簡化內鏡評分(SES-CD)與臨床和實驗室指標相關性的研究. 胃腸病學, 2017, 22(3): 157-162.

1. Rozpondek P, Zwolińska-Wcis?o M, Przybylska M, et al. Effectiveness of anti-TNF alpha antibodies in treatment of fistulizing Crohn’s disease. Przegl Lek, 2011, 68(9): 602-605.
2. Caprilli R, Gassull MA, Escher JC, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut, 2006, 55(Suppl 1): i36-i58.
3. 竺平, 陳玉根, 谷云飛, 等. 單中心肛周克羅恩病臨床特點分析. 中華胃腸外科雜志, 2016, 19(12): 1384-1388.
4. 中華醫學會消化病學分會炎癥性腸病學組. 炎癥性腸病營養支持治療專家共識(2013 · 深圳). 中華內科雜志, 2013, 52(12): 1082-1087.
5. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol, 2005, 19 Suppl A: 5A-36A.
6. Best WR, Becktel JM, Singleton JW, et al. Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology, 1976, 70(3): 439-444.
7. Irvine EJ. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. McMaster IBD Study Group. J Clin Gastroenterol, 1995, 20(1): 27-32.
8. American Gastroenterological Association Clinical Practice Committee. American Gastroenterological Association medical position statement: perianal Crohn’s disease. Gastroenterology, 2003, 125(5): 1503-1507.
9. Loftus EV Jr, Sandborn WJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North America, 2002, 31(1): 1-20.
10. 李冠煒, 任建安. 重視我國克羅恩病流行病學的研究. 腸外與腸內營養, 2017, 24(3): 135-137.
11. Song XM, Gao X, Li MZ, et al. Clinical features and risk factors for primary surgery in 205 patients with Crohn’s disease: analysis of a South China cohort. Dis Colon Rectum, 2011, 54(9): 1147-1154.
12. Ponder A, Long MD. A clinical review of recent findings in the epidemiology of inflammatory bowel disease. Clin Epidemiol, 2013, 5: 237-247.
13. Zeng Z, Zhu Z, Yang Y, et al. Incidence and clinical characteristics of inflammatory bowel disease in a developed region of Guangdong Province, China: a prospective population-based study. J Gastroenterol Hepatol, 2013, 28(7): 1148-1153.
14. Zhao J, Ng SC, Lei Y, et al. First prospective, population-based inflammatory bowel disease incidence study in mainland of China: the emergence of " western” disease. Inflamm Bowel Dis, 2013, 19(9): 1839-1845.
15. Ng SC, Leung WK, Shi HY, et al. Epidemiology of inflammatory bowel disease from 1981 to 2014: results from a territory-wide population-based registry in Hong Kong. Inflamm Bowel Dis, 2016, 22(8): 1954-1960.
16. Kuo CJ, Yu KH, See LC, et al. The trend of inflammatory bowel diseases in Taiwan: a population-based study. Dig Dis Sci, 2015, 60(8): 2454-2462.
17. Gomollón F, Dignass A, Annese V, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 1: diagnosis and medical management. J Crohns Colitis, 2017, 11(1): 3-25.
18. Gionchetti P, Dignass A, Danese S, et al. 3^rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: part 2: surgical management and special situations. J Crohns Colitis, 2017, 11(2): 135-149.
19. 楊柏霖, 竺平, 孫桂東. 克羅恩病肛瘺的診斷與治療. 世界華人消化雜志, 2009, 17(20): 2058-2063.
20. Gecse KB, Bemelman W, Kamm MA, et al. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut, 2014, 63(9): 1381-1392.
21. Siegmund B, Feakins RM, Barmias G, et al. Results of the fifth scientific workshop of the ECCO (Ⅱ): pathophysiology of perianal fistulizing disease. J Crohns Colitis, 2016, 10(4): 377-386.
22. Kalluri R, Neilson EG. Epithelial-mesenchymal transition and its implications for fibrosis. J Clin Invest, 2003, 112(12): 1776-1784.
23. Scharl M, Huber N, Lang S, et al. Hallmarks of epithelial to mesenchymal transition are detectable in Crohn’s disease associated intestinal fibrosis. Clin Transl Med, 2015, 4: 1.
24. Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology, 2008, 135(4): 1106-1113.
25. Louis E, Collard A, Oger AF, et al. Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut, 2001, 49(6): 777-782.
26. Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med, 2001, 135(10): 906-918.
27. 袁柏思, 金鑫鑫, 路又可, 等. 克羅恩病簡化內鏡評分(SES-CD)與臨床和實驗室指標相關性的研究. 胃腸病學, 2017, 22(3): 157-162.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the clinical characteristics of 139 patients with Crohn’s disease combined withperianal fistula in a single center

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