Course and treatment of perianal disease in children newly diagnosed with Crohn's disease

David J. Keljo, James Markowitz, Christine Langton, Trudy Lerer, Athos Bousvaros, Ryan Carvalho, Wallace Crandall, Jonathan Evans, Anne Griffiths, Marsha Kay, Subra Kugathasan, Neil LeLeiko, David Mack, Petar Mamula, M. Susan Moyer, Maria Oliva-Hemker, Anthony Otley, Marian Pfefferkorn, Joel Rosh, Jeffrey S. Hyams

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


Background: We sought to characterize perianal disease and its treatment in pediatric patients newly diagnosed with Crohn's disease. Methods: Data were obtained from the Pediatric Inflammatory Bowel Disease (IBD) Collaborative Group Registry, a prospective, multicenter observational registry recording clinical and laboratory outcomes in children under 16 years of age newly diagnosed with IBD. Patients with Crohn's disease were selected who had data on perianal disease and at least 24 months of follow-up. The records of patients with a Pediatric Crohn's Disease Activity Index perianal subscore greater than 0 were reviewed, and patients with abscesses or fistulas were selected. The therapies used and the course of their perianal disease were then assessed. Results: Of the 276 patients identified, 41 had perianal lesions within 30 days of diagnosis. Thirteen of these had skin tags and fissures only, whereas 28 had fistulas and/or abscesses. The latter lesions resolved by 1 year in 20 patients, and 8 had chronic/recurrent perianal disease persisting for more than 1 year following diagnosis. Patients with fistulizing disease were much more likely to be treated and were treated earlier with antibiotics, infliximab, and immunomodulators than were nonfistulizing patients. Patients who developed chronic perianal disease were more likely to have low body mass indices and required more perianal surgery than did patients whose perianal disease resolved. Conclusions: Approximately 10% of newly diagnosed pediatric patients with Crohn's disease will have perianal fistulas and/or abscesses at the time of diagnosis. Most of these will resolve within a year with medical therapy alone.

Original languageEnglish (US)
Pages (from-to)383-387
Number of pages5
JournalInflammatory bowel diseases
Issue number3
StatePublished - 2009


  • Anus disease
  • Crohn's disease
  • Pediatric
  • Rectal fistula

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology


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