Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn’s Disease in Korea: Results from the CONNECT Study
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: The disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population. Methods: The retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for <12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses. Results: The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses. Conclusions: Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.
Abstract
Background/Aims: The disease course and factors associated with poor prognosis in Korean patients with Crohn’s disease (CD) have not been fully determined. The aim of this study was to explore potential associations between the clinical characteristics and long-term outcomes of CD and perianal fistulas in a Korean population. Methods: The retrospective Crohn’s Disease Clinical Network and Cohort (CONNECT) study enrolled patients diagnosed with CD between July 1982 and December 2008 from 32 hospitals. Those followed for <12 months were excluded. Clinical outcomes were CD-related surgery and complications, including nonperianal fistulas, strictures, and intra-abdominal abscesses. Results: The mean follow-up period was 8.77 years (range, 1.0 to 25.8 years). A total of 1,193 CD patients were enrolled, of whom 465 (39.0%) experienced perianal fistulas. Perianal fistulizing CD was significantly associated with younger age, male gender, CD diagnosed at primary care clinics, and ileocolonic involvement. Both nonperianal fistulas (p=0.034) and intra-abdominal abscesses (p=0.020) were significantly more common in CD patients with perianal fistulas than in those without perianal fistulas. The rates of complicated strictures and CD-related surgery were similar between the groups. Independently associated factors of nonperianal fistulas were perianal fistulas (p=0.015), female gender (p=0.048), CD diagnosed at referral hospital (p=0.003), and upper gastrointestinal (UGI) involvement (p=0.001). Furthermore, perianal fistulas (p=0.048) and UGI involvement (p=0.012) were independently associated with the risk of intra-abdominal abscesses. Conclusions: Perianal fistulas predicted the development of nonperianal fistulas and intra-abdominal abscesses in Korean CD patients. Therefore, patients with perianal fistulizing CD should be carefully monitored for complicated fistulas or abscesses.
참고문헌 (47)
- 김은수, "Inflammatory Bowel Disease in Korea: Epidemiological, Genomic, Clinical, and Therapeutic Characteristics", Gut and Liver, 4(1), pp.1~14 (2010), 거트앤리버 소화기연관학회협의회
- 유수현, "Fatigue Severity and Factors Associated with High Fatigue Levels in Korean Patients with Inflammatory Bowel Disease", Gut and Liver, 8(2), pp.148~153 (2014), 거트앤리버 소화기연관학회협의회
- 이승훈, "Immunological pathogenesis of inflammatory bowel disease", Intestinal research, 16(1), pp.26~42 (2018), 대한장연구학회
- 김영선, "Impact of inflammatory bowel disease on daily life: an online survey by the Korean Association for the Study of Intestinal Diseases", Intestinal research, 15(3), pp.338~344 (2017), 대한장연구학회
- Abraham C, "Inflammatory bowel disease", N Engl J Med, 361, pp.2066~2078 (2009)[DOI]
- Knights D, "Advances in inflammatory bowel disease pathogenesis: linking host genetics and the microbiome", Gut, 62, pp.1505~1510 (2013)[DOI]
- Hiroko Nagao-Kitamoto, "Pathogenic role of the gut microbiota in gastrointestinal diseases", Intestinal research, 14(2), pp.127~138 (2016), 대한장연구학회
- Chen-Wang Chang, "Intestinal Stricture in Crohn’s Disease", Intestinal research, 13(1), pp.19~26 (2015), 대한장연구학회[DOI]
- Thia KT, "An update on the epidemiology of inflammatory bowel disease in Asia", Am J Gastroenterol, 103, pp.3167~3182 (2008)[DOI]
- Hugot JP, "Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease", Nature, 411, pp.599~603 (2001)[DOI]
- Ogura Y, "A frameshift mutation in NOD2 associated with susceptibility to Crohn's disease", Nature, 411, pp.603~606 (2001)[DOI]
- Croucher PJ, "Haplotype structure and association to Crohn's disease of CARD15 mutations in two ethnically divergent populations", Eur J Hum Genet, 11, pp.6~16 (2003)[DOI]
- Inoue N, "Lack of common NOD2 variants in Japanese patients with Crohn's disease", Gastroenterology, 123, pp.86~91 (2002)[DOI]
- Guo QS, "NOD2 3020insC frameshift mutation is not associated with inflammatory bowel disease in Chinese patients of Han nationality", World J Gastroenterol, 10, pp.1069~1071 (2004)[DOI]
- Yang SK, "Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005: a KASID study", Inflamm Bowel Dis, 14, pp.542~549 (2008)[DOI]
- Oriuchi T, "Clinical course and longterm prognosis of Japanese patients with Crohn's disease: predictive factors, rates of operation, and mortality", J Gastroenterol, 38, pp.942~953 (2003)[DOI]
- 임종필, "Adalimumab or infliximab: which is better for perianal fistula in Crohn’s disease?", Intestinal research, 15(2), pp.147~148 (2017), 대한장연구학회
- Jin Young Yoon, "Effects of Perianal Involvement on Clinical Outcomes in Crohn’s Disease over 10 Years", Gut and Liver, 12(3), pp.297~305 (2018), 거트앤리버 소화기연관학회협의회
- Ingle SB, "The natural history of perianal Crohn's disease", Dig Liver Dis, 39, pp.963~969 (2007)[DOI]
- 천재희, "Crohn’s Disease Clinical Network and Cohort (CONNECT) Study: The First Step Toward Nationwide Multicenter Research of Crohn’s Disease in Korea", Intestinal research, 12(3), pp.173~175 (2014), 대한장연구학회
- Jung YS, "Long-term clinical outcomes of urban versus rural environment in Korean patients with Crohn's disease: results from the CONNECT study", J Crohns Colitis, 9, pp.246~251 (2015)[DOI]
- Moon CM, "Clinical factors and disease course related to diagnostic delay in Korean Crohn's disease patients: results from the CONNECT Study", PLoS One, 10, pp.e0144390~ (2015)[DOI]
- Kim B, "Crohn's disease prognosis and early immunomodulator therapy: Results from the CONNECT study", J Gastroenterol Hepatol, 31, pp.126~132 (2016)[DOI]
- Doh YS, "The clinical characteristics of patients with free perforation in Korean Crohn's disease: results from the CONNECT study", BMC Gastroenterol, 15, pp.31~ (2015)[DOI]
- 김남희, "Long-Term Clinical Outcomes of Korean Patient With Crohn’s Disease Following Early Use of Infliximab", Intestinal research, 12(4), pp.281~286 (2014), 대한장연구학회
- Satsangi J, "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications", Gut, 55, pp.749~753 (2006)[DOI]
- Kamm MA, "Perianal fistulizing Crohn's disease: a call to action", Clin Gastroenterol Hepatol, 6, pp.7~10 (2008)[DOI]
- Henckaerts L, "Genetic risk profiling and prediction of disease course in Crohn's disease patients", Clin Gastroenterol Hepatol, 7, pp.972~980 (2009)[DOI]
- Yoneno K, "Risk and management of intra-abdominal abscess in Crohn's disease treated with infliximab", Digestion, 89, pp.201~208 (2014)[DOI]
- Tang LY, "Are perineal and luminal fistulas associated in Crohn's disease? A population-based study", Clin Gastroenterol Hepatol, 4, pp.1130~1134 (2006)[DOI]
- Sachar DB, "Is perianal Crohn's disease associated with intestinal fistulization", Am J Gastroenterol, 100, pp.1547~1549 (2005)[DOI]
- Cosnes J, "Long-term evolution of disease behavior of Crohn's disease", Inflamm Bowel Dis, 8, pp.244~250 (2002)[DOI]
- Thia KT, "Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort", Gastroenterology, 139, pp.1147~1155 (2010)[DOI]
- Gelbmann CM, "Prior bowel resections, perianal disease, and a high initial Crohn's disease activity index are associated with corticosteroid resistance in active Crohn's disease", Am J Gastroenterol, 97, pp.1438~1445 (2002)[DOI]
- Beaugerie L, "Predictors of Crohn's disease", Gastroenterology, 130, pp.650~656 (2006)[DOI]
- Lapidus A, "Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients", Gastroenterology, 114, pp.1151~1160 (1998)[DOI]
- Han YM, "Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection", J Gastroenterol Hepatol, 31, pp.1436~1442 (2016)[DOI]
- Ji Won Kim, "Results of the first survey for the current status of inflammatory bowel disease management in Asian countries", Intestinal research, 14(3), pp.199~201 (2016), 대한장연구학회
- American Gastroenterological Association Clinical Practice Committee, "American Gastroenterological Association medical position statement: perianal Crohn's disease", Gastroenterology, 125, pp.1503~1507 (2003)[DOI]
- Ye BD, "Clinical features and long-term prognosis of Crohn's disease in Korea", Scand J Gastroenterol, 45, pp.1178~1185 (2010)[DOI]
- Hellers G, "Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease", Gut, 21, pp.525~527 (1980)[DOI]
- Lapidus A, "Crohn's disease in Stockholm County during 1990-2001: an epidemiological update", World J Gastroenterol, 12, pp.75~81 (2006)[DOI]
- Schwartz DA, "The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota", Gastroenterology, 122, pp.875~880 (2002)[DOI]
- Moon CM, "Clinical features and predictors of clinical outcomes in Korean patients with Crohn's disease: a Korean association for the study of intestinal diseases multicenter study", J Gastroenterol Hepatol, 29, pp.74~82 (2014)[DOI]
- Wee Khoon Ng, "Changing epidemiological trends of inflammatory bowel disease in Asia", Intestinal research, 14(2), pp.111~119 (2016), 대한장연구학회
- Zallot C, "Clinical risk factors for complicated disease: how reliable are they", Dig Dis, 30(Suppl 3), pp.67~72 (2012)[DOI]
- 양동훈, "Usefulness of C-Reactive Protein as a Disease Activity Marker in Crohn’s Disease according to the Location of Disease", Gut and Liver, 9(1), pp.80~86 (2015), 거트앤리버 소화기연관학회협의회
