Perianal Fistulas as a First Sign of Crohn’s Disease

The frequency and diagnostic delay of perianal fistulas (PAFs) as the first manifestation of Crohn’s disease (CD) highlights the need for increased clinical awareness, according to a systematic review published in the Journal of Clinical Medicine

The analysis included 17 studies comprising 34,030 patients with CD. Researchers found that PAFs preceded a CD diagnosis in 8.6% of cases (95% CI, 5.72-12.71), with a weighted mean time to diagnosis of 45.9 months (±31.3). These findings underscore a significant diagnostic delay in recognizing CD in patients initially presenting with PAFs.

Notable variations were observed across different subgroups. Asian populations demonstrated a significantly higher incidence of PAFs preceding CD (17.66%; 95% CI, 11.45-26.25) compared with non-Asians (4.99%; 95% CI, 3.75-6.60), with an odds ratio (OR) of 3.99 (p < 0.0001). In adolescents, PAFs preceded CD in 9.17% of cases (95% CI, 5.92-13.93), whereas incidences were lower in pediatric (6.38%; 95% CI, 1.84-19.85; OR, 0.53; p < 0.0001) and elderly-onset CD populations (3.77%; 95% CI, 1.68-8.25; OR, 0.44; p = 0.0035).

Despite the insights, data on sex-based differences in PAF incidence were unavailable.

The findings suggest that nearly 10% of patients with CD present with a PAF before their diagnosis, with an average diagnostic delay of nearly 4 years. The study authors emphasized the importance of heightened clinical vigilance to facilitate earlier recognition and intervention for CD in patients presenting with PAFs. Early diagnosis could improve patient outcomes and reduce complications.

Reference
Munster LJ, Mönnink GLE, van Dieren S, et al. Fistulizing perianal disease as a first manifestation of crohn's disease: A systematic review and meta-analysis. J Clin Med. Published online August 12, 2024. doi:10.3390/jcm13164734