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P264. Clinical features and prognosis of fistulizing perianal Crohn's disease in Korea

J. Chun1, S.W. Hwang1, J.H. Kim1, J.P. Im1, B.D. Ye2, J.W. Kim3, Y.S. Kim4, J.S. Kim5, 1Seoul National University College of Medicine, Internal Medicine and Liver Research Institute, Seoul, Korea, Republic of, 2University of Ulsan College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 3Seoul National University Boramae Hospital, Seoul National University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 4Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 5Seoul National Uinversity College of Medicine, Internal Medicine and Liver Research Institute, Seoul, Korea, Republic of

Background

Differences in genetic susceptibility and clinical characteristics have been reported between Asian and Caucasian patients with Crohn's disease (CD). However, the disease course and risk factors of poor prognosis in Asian CD patients has not been fully determined. Moreover, the clinical features and long-term prognosis of CD in patients with fistulizing perianal CD remain unclear. The aim of this study is to assess the clinical characteristics and long-term outcome of CD patients according to presence of perianal fistula in a Korean population.

Methods

This retrospective multicenter cohort study included patients diagnosed with CD between July 1982 and December 2008 from 29 hospitals in Korea. Those who had a follow-up period shorter than 12 months were excluded. The primary endpoints were CD-related complications including non-perianal fistula, stricture, and intra-abdominal abscess.

Results

A total of 1,026 CD patients were enrolled. The mean follow-up period was 8.46 years (range, 1.0–26.4). Three hundred ninety-nine (38.9%) CD patients experienced perianal fistula. Among them, perianal fistula was detected before and after diagnosis of CD in 274 (68.7%) and 125 (31.3%), respectively. Fistulizing perianal CD was significantly associated with younger age (40 years old or less), diagnosis of CD at primary or secondary care clinics, and ileocolonic involvement (L3 according to the Montreal classification). In addition, complications of non-perianal fistula (p = 0.025) and intra-abdominal abscess (p = 0.003) were significantly more common in patients with fistulizing perianal CD than in those without fistulizing perianal CD. In contrast, complication of stricture was not associated with fistulizing perianal CD (p = 0.106). Independent risk factors for complication of non-perianal fistula were female (adjusted hazard ratio [HR], 1.408; 95% confidence interval [CI], 1.031–1.924; p = 0.031), perianal fistula (adjusted HR, 1.407; 95% CI, 1.032–1.917; p = 0.031), and upper gastrointestinal involvement (L4 according to the Montreal classification; adjusted HR, 1.472; 95% CI, 1.051–2.060; p = 0.024). Furthermore, independent risk factors for complication of intra-abdominal abscess were perianal fistula (adjusted HR, 1.484; 95% CI, 1.063–2.072; p = 0.021), and upper gastrointestinal involvement (adjusted HR, 1.451; 95% CI, 1.004–2.096; p = 0.047).

Conclusion

In Korean CD patients, perianal fistula is an independent predictor for complications of non-perianal fistula and intra-abdominal abscess. Therefore, patients with fistulizing perianal CD should be carefully monitored for development of non-perianal fistula and intra-abdominal abscess.