P188 Incidence and clinical features of perianal diseases in patients with ulcerative colitis in Korea
Y. S. Choi*1, W. J. Kim2, J. K. Kim1, K.-H. Song3, H.-J. Jung3
1Daehang Hospital, Gastroenterology, Seoul, South Korea, 2Soonchunhyang University Hospital, Gastroenterology, Gumi-si, South Korea, 3Daehang Hospital, Surgery, Seoul, South Korea
Even though perianal complications are characteristic in Crohn’s disease (CD), they are thought to have rare associations with ulcerative colitis (UC). However, some patients with UC suffer from perianal problems. Bleeding haemorrhoids or fissures can be confused with relapse of UC, which may lead to inappropriate management, and development of fistula or abscess in UC may raise doubts of misdiagnosed CD. However, there are rare recent reports concerning the incidence and clinical characteristic of perianal disease (PAD) in patients with UC. The aims of our study were to estimate the incidence of PAD in patients with UC, and to analyse the clinical characteristics and the risk factors for the development of PAD in UC.
We reviewed the data of 944 patients with an initial diagnosis of UC at Daehang Hospital, Seoul, and Soonchunhyang University Hospital, Gumi-si, Korea from October 2003 to October 2015. Perianal diseases were categorised as haemorrhoids, fissure, abscess, and fistula after anoscopic examination by experienced proctologists. Data on patient demographics, incidence and types of perianal disease, activity or extent of UC, family history, smoking history, medication (systemic corticosteroid, immunosuppressant, or anti-tumour necrosis factor), surgical therapy, and clinical course of PAD were analysed.
The median follow-up period was 58 months (range 12–142 months). Of the 944 patients with UC, the overall incidence rate of PAD was 21.0% (198/944). The incidences of symptomatic haemorrhoids, anal fissure, abscess, and fistula were 11.7%, 6.9%, 2.0%, and 2.1%, respectively. Surgery for PAD was performed in 73 patients (7.7%). The rates of surgery for haemorrhoids, anal fissure, abscess, and fistula were 4.4%, 0.5%, 1.1%, and 1.8%, respectively. Perianal abscess or fistula was found in 35 patients (3.7%). Of these 35 patients, 28 patients (80%) underwent surgical treatment. Amongst these, 25 patients (89.3%) showed no recurrence of abscess or fistula during the follow-up. In a multivariate analysis, male gender (OR = 4.6; 95% CI = 1.7–12.5), extensive disease (OR = 4.2; 95% CI = 1.6–10.9), and use of immunosuppressant (OR = 3.3; 95% CI = 1.2–9.6) were significantly associated with the development of perianal abscess or fistula.
PAD can occur in patients with UC and in those with CD, but its clinical course is less serious than that of CD. Careful examination and management for perianal disease is needed to improve quality of life in patients with UC.