Perianal Crohn's Disease Is Associated With Poor Disease Outcome: A Nationwide Study From the epiIIRN Cohort

Ohad Atia, Noa Asayag, Gili Focht, Rona Lujan, Oren Ledder, Shira Greenfeld, Revital Kariv, Iris Dotan, Hagit Gabay, Ran Balicer, Ziona Haklai, Daniel Nevo, Dan Turner

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background & Aims: Limited population-based data have explored perianal involvement in Crohn's disease (CD) and compared the disease course between severe and non-severe perianal CD (PCD). We aimed to explore the disease course of these phenotypes in a population-based study of CD. Methods: Cases were identified from the epi-IIRN cohort and included 2 Israeli health maintenance organizations covering 78% of the population. We validated specific algorithms to identify fistulizing PCD and to differentiate severe from non-severe disease by medication utilization, International Classification of Disease, 9th Revision codes, and perianal procedures. Results: A total of 12,904 CD patients were included in an inception cohort from 2005 (2186 pediatric-onset, 17%) providing 86,119 person-years of follow-up. Fistulizing PCD was diagnosed in 1530 patients (12%) (574 with severe PCD, 4%). The prevalence of PCD was 7.9%, 9.4%, 10.3%, and 11.6% at 1, 3, 5, and 10 years from CD diagnosis, respectively. At 5 years, PCD patients were more likely to be hospitalized (36% in non-PCD vs 64% in PCD; P < .001), undergo inflammatory bowel disease–related surgeries (9% vs 38%, respectively; P < .001), and develop anorectal cancer (1.2/10,000 person-years for non-PCD vs 4.2/10,000 for PCD; P = .01). Severe PCD was associated with poorer outcomes compared with non-severe PCD, as shown for hospitalizations (61% in non-severe PCD vs 73% in severe; P = .004) and surgeries (35% vs 43%; P = .001). Conclusions: Despite higher utilization of immunomodulators and biologics, PCD is associated with poor disease outcomes, especially in severe PCD.

Original languageEnglish
Pages (from-to)e484-e495
JournalClinical Gastroenterology and Hepatology
Issue number3
StatePublished - 1 Mar 2022
Externally publishedYes


  • Crohn's Disease
  • Outcomes
  • Perianal Disease

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


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