A child presents with perianal symptoms - how often is this Crohn's disease?
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Read the article on jpedsurg.org ↗Article · Nov 2020 · 1 min read
In brief
In brief
Retrospective study of 1,140 children with perianal symptoms found 3% were later diagnosed with Crohn's disease. Highest-risk patients were males aged 10+ with perianal fistulas (35% incidence), warranting expedited IBD workup when these features are present.
Written by the GCMD Library team from the article.
Abstract
Background
The cumulative incidence and predictors of future diagnosis of Crohn's disease (CD) following presentation with perianal symptoms, such as anorectal abscess, fistula or fissure, is unknown.
Methods
A 5-year retrospective review of children presenting with perianal symptoms without prior CD diagnosis was performed. Institutional cumulative incidence of CD was calculated to determine the risk of CD presenting with perianal symptoms.
Results
1140 children presented for evaluation of an anorectal abscess (n = 232), fistula (n = 49), or fissure (n = 859). Thirty-five were later diagnosed with CD, resulting in an incidence of 3%. Prognostic indicators of future CD diagnosis included increased age per every additional year (RR 1.19, 95% CI: 1.14–1.25, p < 0.001), male sex (RR 2.12, 95% CI 1.07–4.22, p = 0.024), or perianal fistula (RR 4.67, 95% CI 2.26–9.67, p = 0.022). Among those diagnosed with CD, 57% experienced and had a documented history of a CD-associated symptom prior to perianal symptom onset. Absence of symptoms resulted in delayed diagnosis (43 vs 3 days, p < 0.02).
Conclusion
Of children presenting with a perianal symptom, three percent will eventually be diagnosed with CD. At highest risk (35%) were males aged 10 years or older with a perianal fistula; which should prompt expeditious workup.