Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn’s Disease: A Population-based Study

Abstract Introduction Most studies of elderly-onset Crohn’s disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the pre...

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Veröffentlicht in:Journal of Crohn's and colitis 2020-05, Vol.14 (4), p.501-507
Hauptverfasser: Danielou, Marie, Sarter, Hélène, Pariente, Benjamin, Fumery, Mathurin, Ley, Delphine, Mamona, Christel, Barthoulot, Maël, Charpentier, Cloé, Siproudhis, Laurent, Savoye, Guillaume, Gower-Rousseau, Corinne
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Sprache:eng
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Zusammenfassung:Abstract Introduction Most studies of elderly-onset Crohn’s disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD. Method All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD. Results A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10–4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6–5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up. Conclusion During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.
ISSN:1873-9946
1876-4479
DOI:10.1093/ecco-jcc/jjz173