Introduction There is no comparative data on outcomes in perianal fistulas in paediatric/adolescent versus adult onset CD. Management paradigms in perianal fistulas in Crohn’s disease is not fully defined and approaches from paediatric and adult IBD clinicians and surgeons may be different. We aimed to study any differences in diagnostic and treatment approaches and outcomes in paediatric/adolescent onset CD with perianal fistula (CD-PAF) and adult onset disease.
Method Data was collected on patients included in 2 retrospective multicentre multinational cohorts (11 adult and 7 paediatric centres) of perianal fistula with paediatric/adolescent onset and adult onset CD PAF. We evaluated fistula characteristics, surgical and medical treatments following onset of CD-PAF and fistula healing. We also compared re-intervention rates:the need for re-insertion of seton or abscess drainage or diverting stoma or proctectomy.
Results 253 adults and 116 paediatric/adolescent patients were included. Complex fistulas were identified in 53% of adult and 67% of paediatric/adolescent group. Proctitis was recorded in 43% of adult onset and in 3% of paediatric/adolescent onset CD-PAF. Significantly higher proportion of adult CD-PAF patients had seton insertion (15% vs 54%, p<0.001). Anti TNF use was more often is paediatric onset CD-PAF (83% vs 68%). Complete clinical fistula healing was more often noted in paediatric/adolescent onset CD-PAF (71% vs 49%, p=0.015). Reintervention rates were higher in adult onset CD (40.3% vs 16.05%, p=<0.001. Radical surgery (diverting stoma or proctectomy) was required in 3 patients (2.58%) with paediatric/adolescent onset and 26 patients (10.28%) with adult onset CD-PAF (p=0.04).
Conclusion Paediatric/adolescent onset CD-PAF appears to have better outcomes with less radical surgery or re-interventions when compared to adult onset disease despite less frequent use of seton.
Disclosure of Interest None Declared