Original Contribution
The American Journal of Gastroenterology (2005) 100, 1547–1549; doi:10.1111/j.1572-0241.2005.40980.x
Is Perianal Crohn's Disease Associated with Intestinal Fistulization?
David B Sachar MD1, Carol A Bodian DPH1, Eric S Goldstein MD1, Daniel H Present MD1, Theodore M Bayless MD2, Michael Picco MD2,3, Ruud A van Hogezand MD4, Vito Annese MD5, Judith Schneider6, Burton I Korelitz MD6 and Jacques Cosnes MD7 for the Task Force on Clinical Phenotyping of the IOIBD
- 1Mount Sinai School of Medicine, New York;
- 2Johns Hopkins School of Medicine, Maryland;
- 3Mayo Clinic, Florida;
- 4Leiden University Medical Center, Leiden, The Netherlands;
- 5CSS-IRCCS Hospital, San Giovanni Rotondo, Italy;
- 6Lenox Hill Hospital, New York;
- 7St. Antoine Hospital, Paris, France
Correspondence: David B. Sachar, Mount Sinai School of Medicine, Box 1069, One Gustave L. Levy Place, New York, NY 10029-6574
Received 19 June 2004; Revised 0000; Accepted 19 January 2005.
Abstract
BACKGROUND:
When cases of Crohn's disease (CD) are described as "fistulizing," distinctions are often not drawn between perianal and intestinal fistulization. The question, therefore, remains open as to whether or not there is truly an association between perianal fistulization and intraabdominal intestinal fistulization in CD.
AIMS:
We have sought to determine the association between perianal and intestinal fistulization by analyzing the cases of CD recorded in databases from six international centers.
PATIENTS:
Six databases provided information on 5491 cases of CD in the United States, France, Italy, and The Netherlands. Of these cases, 1686 had isolated ileal disease and 1655 had Crohn's colitis.
METHODS:
An association between perianal disease and internal fistulae was sought by calculating relative risks for the chance of internal fistulae among patients with perianal fistulae relative to those without. Statistical significance was calculated by the Mantel-Haenszel procedure, stratifying on the separate centers. All statistical tests and estimates were implemented using SAS for the PC.
RESULTS:
Among the 1686 cases with isolated ileal disease, the evidence of an association between perianal disease and internal fistulization was not consistent across centers, with relative risks ranging from 0.8 to 2.2. For patients with Crohn's colitis (n = 1655), the association was much stronger and more consistent, with an estimated common relative risk of 3.4, 95% confidence interval (2.6–4.6, p < 0.0001).
CONCLUSIONS:
We have found a statistically significant association between perianal CD and intestinal fistulization, much stronger and more consistent in cases of Crohn's colitis than in cases limited to the small bowel.
