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Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The aim of this study is to describe the long-term course of anorectal complains and function in a single centre cohort patients suffering from inflammatory bowel disease (IBD) with perianal lesions.

Methods

Between 1993 and 2000, 56 IBD patients (43 Crohn’s disease and 13 ulcerative colitis) with perianal complaints underwent anorectal function evaluation (AFE) (baseline). For follow-up, they were approached between 2010 and 2012 by sending questionnaires including Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ), Perianal Disease Activity Index (PDAI), faecal incontinence scale (Vaizey) and an invitation for AFE.

Results

At follow-up, 46 patients (82 %) were available, 9 (16 %) were lost and 1 (2 %) had died. Thirty patients returned the questionnaires of which 17 also underwent AFE. The remaining 16 patients were interviewed by phone and were only willing to mention their anorectal complaints. Median follow-up was 14 year. In 25 of the 46 patients (54 %), perianal complaints persisted faecal incontinence (n = 7); soiling (n = 13) and active fistula (n = 5). Eighteen (39 %) patients had an active fistula at baseline and three persisted at follow-up. Two developed a new fistula. Mean IBDQ, Vaizey and PDAI were 178 (SD 29), 7 (SD 5) and 4.2 (SD 3.0), respectively. In 17 patients, who underwent AFE, anal endosonography showed healing in nine of the ten fistulas. Anal pressures as well as rectal capacity remained unaltered in the individual patient, but showed a large range within the group.

Conclusion

After 14 years, 54 % of the IBD patients with perianal lesions still have mild complaints. The quality of life remained moderate over a long period, which is concerning.

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References

  1. Eglinton TW, Barclay ML, Gearry RB, Frizelle FA (2012) The spectrum of perianal Crohn’s disease in a population-based cohort. Dis Colon Rectum 55(7):773–777

    Article  PubMed  Google Scholar 

  2. McKee RF, Keenan RA (1996) Perianal Crohn’s disease–is it all bad news? Dis Colon Rectum 39(2):136–142

    Article  CAS  PubMed  Google Scholar 

  3. Vermeire S, Van AG, Rutgeerts P (2007) Perianal Crohn’s disease: Classification and clinical evaluation. Dig Liver Dis 39(10):959–962

    Article  CAS  PubMed  Google Scholar 

  4. Lockhart-Mummery HE, Morson BC (1964) Crohn’s disease of the large intestine. Gut 5:493–509

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Hamzaoglu I, Hodin RA (2005) Perianal problems in patients with ulcerative colitis. Inflamm Bowel Dis 11(9):856–859

    Article  PubMed  Google Scholar 

  6. Zabana Y, Van DM, Garcia-Planella E et al (2011) Perianal disease in patients with ulcerative colitis: a case–control study. J Crohns Colitis 5(4):338–341

    Article  PubMed  Google Scholar 

  7. Chang L, Munakata J, Mayer EA et al (2000) Perceptual responses in patients with inflammatory and functional bowel disease. Gut 47(4):497–505

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Farthing MJ, Lennard-Jones JE (1978) Sensibility of the rectum to distension and the anorectal distension reflex in ulcerative colitis. Gut 19(1):64–69

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Loening-Baucke V, Metcalf AM, Shirazi S (1989) Anorectal manometry in active and quiescent ulcerative colitis. Am J Gastroenterol 84(8):892–897

    CAS  PubMed  Google Scholar 

  10. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG (1990) Anorectal function investigations in incontinent and continent patients. Differences and discriminatory value. Dis Colon Rectum 33(6):479–485

    Article  CAS  PubMed  Google Scholar 

  11. Silvis R, van Eekelen JW, Delemarre JB, Gooszen HG (1995) Endosonography of the anal sphincter after ileal pouch-anal anastomosis. Relation with anal manometry and fecal continence. Dis Colon Rectum 38(4):383–388

    Article  CAS  PubMed  Google Scholar 

  12. Wiese DM, Schwartz DA (2012) Managing perianal Crohn’s disease. Curr Gastroenterol Rep 14(2):153–161

    Article  PubMed  Google Scholar 

  13. Lam TJ, Kuik DJ, Felt-Bersma RJ (2012) Anorectal function evaluation and predictive factors for faecal incontinence in 600 patients. Colorectal Dis 14(2):214–223

    Article  CAS  PubMed  Google Scholar 

  14. Guyatt G, Mitchell A, Irvine EJ et al (1989) A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology 96(3):804–810

    CAS  PubMed  Google Scholar 

  15. Sandborn WJ, Tremaine WJ, Batts KP, Pemberton JH, Phillips SF (1994) Pouchitis after ileal pouch-anal anastomosis: a Pouchitis Disease Activity Index. Mayo Clin Proc 69(5):409–415

    Article  CAS  PubMed  Google Scholar 

  16. Vaizey CJ, Carapeti E, Cahill JA, Kamm MA (1999) Prospective comparison of faecal incontinence grading systems. Gut 44(1):77–80

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63(1):1–12

    Article  CAS  PubMed  Google Scholar 

  18. Buchmann P, Keighley MR, Allan RN, Thompson H, Alexander-Williams J (1980) Natural history of perianal Crohn’s disease. Ten year follow-up: a plea for conservatism. Am J Surg 140(5):642–644

    Article  CAS  PubMed  Google Scholar 

  19. Makowiec F, Jehle EC, Starlinger M (1995) Clinical course of perianal fistulas in Crohn’s disease. Gut 37(5):696–701

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Schwartz DA, Loftus EV Jr, Tremaine WJ et al (2002) The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 122(4):875–880

    Article  PubMed  Google Scholar 

  21. Ruffolo C, Citton M, Scarpa M et al (2011) Perianal Crohn’s disease: is there something new? World J Gastroenterol 17(15):1939–1946

    Article  PubMed Central  PubMed  Google Scholar 

  22. Renna S, Orlando A, Cottone M (2012) Randomized controlled trials in perianal Crohn’s disease. Rev Recent Clin Trials 7(4):297–302

    CAS  PubMed  Google Scholar 

  23. Mueller MH, Geis M, Glatzle J et al (2007) Risk of fecal diversion in complicated perianal Crohn’s disease. J Gastrointest Surg 11(4):529–537

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Lewis RT, Maron DJ (2010) Anorectal Crohn’s disease. Surg Clin N Am 90(1):83–97

    Article  PubMed  Google Scholar 

  25. Ogawa H, Haneda S, Shibata C et al (2013) Adenocarcinoma associated with perianal fistulas in Crohn’s disease. Anticancer Res 33(2):685–689

    PubMed  Google Scholar 

  26. Beck DE, Harford FJ, Roettger RH (1989) Perianal Bowen’s disease associated with Crohn’s colitis. Report of a case. Dis Colon Rectum 32(3):252–255

    Article  CAS  PubMed  Google Scholar 

  27. Mahadev S, Young JM, Selby W, Solomon MJ (2012) Self-reported depressive symptoms and suicidal feelings in perianal Crohn’s disease. Colorectal Dis 14(3):331–335

    Article  PubMed  Google Scholar 

  28. Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J (2006) Predictors of Crohn’s disease. Gastroenterology 130(3):650–656

    Article  PubMed  Google Scholar 

  29. American Gastroenterological Association medical position statement: perianal Crohn’s disease (2003) Gastroenterology 125(5):1503–1507

  30. Andersson P, Olaison G, Hallbook O, Boeryd B, Sjodahl R (2003) Increased anal resting pressure and rectal sensitivity in Crohn’s disease. Dis Colon Rectum 46(12):1685–1689

    Article  PubMed  Google Scholar 

  31. Mueller MH, Kreis ME, Gross ML et al (2002) Anorectal functional disorders in the absence of anorectal inflammation in patients with Crohn’s disease. Br J Surg 89(8):1027–1031

    Article  CAS  PubMed  Google Scholar 

  32. Chrysos E, Athanasakis E, Tsiaoussis J et al (2001) Rectoanal motility in Crohn’s disease patients. Dis Colon Rectum 44(10):1509–1513

    Article  CAS  PubMed  Google Scholar 

  33. Kangas E, Hiltunen KM, Matikainen M (1992) Anorectal function in Crohn’s disease. Ann Chir Gynaecol 81(1):43–47

    CAS  PubMed  Google Scholar 

  34. Buchmann P, Mogg GA, Alexander-Williams J, Allan RN, Keighley MR (1980) Relationship of proctitis and rectal capacity in Crohn’s disease. Gut 21(2):137–140

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. van Bodegraven AA, Sloots CE, Felt-Bersma RJ, Meuwissen SG (2002) Endosonographic evidence of persistence of Crohn’s disease-associated fistulas after infliximab treatment, irrespective of clinical response. Dis Colon Rectum 45(1):39–45

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

    Tze J. Lam, Adriaan A. van Bodegraven & Richelle J. F. Felt-Bersma

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  1. Tze J. Lam
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  2. Adriaan A. van Bodegraven
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  3. Richelle J. F. Felt-Bersma
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Correspondence to Tze J. Lam.

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Lam, T.J., van Bodegraven, A.A. & Felt-Bersma, R.J.F. Anorectal complications and function in patients suffering from inflammatory bowel disease: a series of patients with long-term follow-up. Int J Colorectal Dis 29, 923–929 (2014). https://doi.org/10.1007/s00384-014-1926-7

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