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.
Bibliographical noteFunding Information:
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).
We thank the Korean Health Insurance Review and Assessment Service and the National Health Insurance Service for providing the insurance claims data.
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
- Inflammatory bowel disease
- Perianal fistula