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Incidence and Outcomes of Perianal Disease in an Asian Population with Crohn’s Disease: A Nationwide Population-Based Study

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Abstract

Background

Little is known about the natural history of perianal fistulas in Asian populations with Crohn’s disease (CD).

Aims

We investigated the incidence and outcomes of perianal CD (pCD) in Korean CD patients.

Methods

A nationwide population-based cohort of 6265 CD patients diagnosed in 2010–2014 was analyzed to investigate the incidence and outcomes of pCD. The results were validated in a hospital-based cohort of 2923 CD patients diagnosed in 1981–2015. Factors associated with pCD development were analyzed. The incidence and outcomes of pCD were compared between the prebiologic and biologic eras.

Results

pCD occurred in 39.2% of the population-based cohort and 56.1% of the hospital-based cohort during the median follow-up of 4.2 and 8.5 years, respectively. The cumulative incidence of pCD was 40.0% at 5 years after CD diagnosis in the population-based cohort and 62.5% at 20 years in the hospital-based cohort. In multivariate analysis, pCD development was positively associated with male sex, younger age and colonic involvement at diagnosis, early diagnosis, and CD diagnosis in the prebiologic era. The cumulative probability of proctectomy at 10, 20, and 30 years after pCD diagnosis was 2.9%, 12.2%, and 16.2%, respectively. The cumulative incidence of pCD occurring after CD diagnosis and the cumulative probability of proctectomy were significantly lower in the biologic era than in the prebiologic era (p < 0.001 and p = 0.03, respectively).

Conclusions

Compared with Western patients with CD, Korean patients show a high incidence of pCD but have a low probability of proctectomy, suggesting the favorable course of pCD.

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References

  1. Vollebregt PF, van Bodegraven AA, Markus-de Kwaadsteniet TML, van der Horst D, Felt-Bersma RJF. Impacts of perianal disease and faecal incontinence on quality of life and employment in 1092 patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2018;47:1253–1260.

    Article  CAS  Google Scholar 

  2. Mahadev S, Young JM, Selby W, Solomon MJ. Quality of life in perianal Crohn’s disease: what do patients consider important? Dis Colon Rectum. 2011;54:579–585.

    Article  Google Scholar 

  3. Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg. 2000;231:38–45.

    Article  CAS  Google Scholar 

  4. Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn’s disease. Gastroenterology. 2006;130:650–656.

    Article  Google Scholar 

  5. Lakatos PL, Czegledi Z, Szamosi T, et al. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease. World J Gastroenterol. 2009;15:3504–3510.

    Article  Google Scholar 

  6. Kobayashi T, Hisamatsu T, Suzuki Y, et al. Predicting outcomes to optimize disease management in inflammatory bowel disease in Japan: their differences and similarities to Western countries. Intest Res. 2018;16:168–177.

    Article  Google Scholar 

  7. Beaugerie L, Carrat F, Nahon S, et al. High risk of anal and rectal cancer in patients with anal and/or perianal Crohn’s disease. Clin Gastroenterol Hepatol. 2018;16:892–899-e892.

    Article  Google Scholar 

  8. Lee HS, Park SH, Yang SK, et al. The risk of colorectal cancer in inflammatory bowel disease: a hospital-based cohort study from Korea. Scand J Gastroenterol. 2015;50:188–196.

    Article  CAS  Google Scholar 

  9. Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122:875–880.

    Article  Google Scholar 

  10. Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010;139:1147–1155.

    Article  Google Scholar 

  11. Park SH, Aniwan S, Scott Harmsen W, et al. Update on the natural course of fistulizing perianal Crohn’s disease in a population-based cohort. Inflamm Bowel Dis. 2019;25:1054–1060.

    Article  Google Scholar 

  12. Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut. 1980;21:525–527.

    Article  CAS  Google Scholar 

  13. Gottgens KW, Jeuring SF, Sturkenboom R, et al. Time trends in the epidemiology and outcome of perianal fistulizing Crohn’s disease in a population-based cohort. Eur J Gastroenterol Hepatol. 2017;29:595–601.

    Article  Google Scholar 

  14. Shi HY, Levy AN, Trivedi HD, Chan FKL, Ng SC, Ananthakrishnan AN. Ethnicity Influences phenotype and outcomes in inflammatory bowel disease: a systematic review and meta-analysis of population-based studies. Clin Gastroenterol Hepatol. 2018;16:190–197-e111.

    Article  Google Scholar 

  15. Mak WY, Mak OS, Lee CK, et al. Significant medical and surgical morbidity in perianal Crohn’s disease: results from a territory-wide study. J Crohns Colitis. 2018;12(12):1392–1398.

    PubMed  Google Scholar 

  16. Chang K, Lee HS, Kim YJ, et al. Increased risk of herpes zoster infection in patients with inflammatory bowel diseases in Korea. Clin Gastroenterol Hepatol. 2018;16:1928–1936-e1922.

    Google Scholar 

  17. Kim HJ, Hann HJ, Hong SN, et al. Incidence and natural course of inflammatory bowel disease in Korea, 2006–2012: a nationwide population-based study. Inflamm Bowel Dis. 2015;21:623–630.

    Article  Google Scholar 

  18. Wei SC. Differences in the public medical insurance systems for inflammatory bowel disease treatment in Asian countries. Intest Res. 2016;14:218–223.

    Article  Google Scholar 

  19. Kim JA, Yoon S, Kim LY, Kim DS. Towards actualizing the value potential of Korea Health Insurance Review and Assessment (HIRA) data as a resource for health research: strengths, limitations, applications, and strategies for optimal use of HIRA data. J Korean Med Sci. 2017;32:718–728.

    Article  Google Scholar 

  20. Park SH, Yang SK, Park SK, et al. Long-term prognosis of Crohn’s disease and its temporal change between 1981 and 2012: a hospital-based cohort study from Korea. Inflamm Bowel Dis. 2014;20:488–494.

    Article  Google Scholar 

  21. Ye BD, Yang SK, Cho YK, et al. Clinical features and long-term prognosis of Crohn’s disease in Korea. Scand J Gastroenterol. 2010;45:1178–1185.

    Article  Google Scholar 

  22. Sjoberg D, Holmstrom T, Larsson M, et al. Incidence and clinical course of Crohn’s disease during the first year—results from the IBD Cohort of the Uppsala Region (ICURE) of Sweden 2005–2009. J Crohns Colitis. 2014;8:215–222.

    Article  Google Scholar 

  23. van den Heuvel TRA, Jeuring SFG, Zeegers MP, et al. A 20-year temporal change analysis in incidence, presenting phenotype and mortality, in the Dutch IBDSL cohort-can diagnostic factors explain the increase in IBD incidence? J Crohns Colitis. 2017;11:1169–1179.

    Article  Google Scholar 

  24. Bell SJ, Williams AB, Wiesel P, Wilkinson K, Cohen RC, Kamm MA. The clinical course of fistulating Crohn’s disease. Aliment Pharmacol Ther. 2003;17:1145–1151.

    Article  CAS  Google Scholar 

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Acknowledgments

We thank the Korean Health Insurance Review and Assessment Service and the National Health Insurance Service for providing the insurance claims data.

Funding

This work was supported by a Korean Health Technology R&D Project Grant from the Korea Health Industry Development Institute to Suk-Kyun Yang (A120176), funded by the Ministry of Health and Welfare. Ho-Su Lee was supported by the National Research Foundation of Korea (NRF) MRC Grant funded by the Korean government (MSIT) (2018R1A5A2020732).

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Author notes

  1. Eun Mi Song and Ho-Su Lee contributed equally to this paper.

Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Eun Mi Song, Eun Hye Oh, Nam Seok Ham, Jeongseok Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung & Suk-Kyun Yang

  2. Department of Biochemistry, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Ho-Su Lee

  3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Ye-Jee Kim

  4. Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Jong Lyul Lee, Yong Sik Yoon & Chang Sik Yu

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  1. Eun Mi Song
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Contributions

EMS, HSL, and SKY were involved in planning and conducting the study. EMS, HSL, YJK, EHO, NSH, JK, SWH, SHP, DHY, BDY, JSB, SJM, YSY, CSY, and SKY contributed to collecting data. EMS, HSL, YJK, and SKY helped in statistical analysis and interpretation of data. EMS and HSL contributed to drafting the manuscript. SKY was involved in study supervision and critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Suk-Kyun Yang.

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Conflict of interest

Suk-Kyun Yang received a research grant from Janssen Korea Ltd.; however, this funding was not related to the topic of this study. The remaining authors have no conflict of interest or financial ties to declare.

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Song, E.M., Lee, HS., Kim, YJ. et al. Incidence and Outcomes of Perianal Disease in an Asian Population with Crohn’s Disease: A Nationwide Population-Based Study. Dig Dis Sci 65, 1189–1196 (2020). https://doi.org/10.1007/s10620-019-05819-9

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  • DOI: https://doi.org/10.1007/s10620-019-05819-9

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