Recognising and Treating Complicated Fissuring Perianal Crohn Disease: A South-East Scotland Cohort Study. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Burgess, Christopher J.; Clark, Claire; Khedim, Cher-Antonia; Armstrong, Katherine; Henderson, Paul; Wilson, David C.
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 74:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: anal fissure -- Crohn disease -- epidemiology -- inflammatory bowel disease -- paediatric; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000003285
• Languages: English
• ISSNs: 0277-2116

Abstract

Abstract : ABSTRACT: Fissuring perianal Crohn disease (CD) is not recognised as a perianal phenotype in Montreal/Paris inflammatory bowel disease classifications; however, can occasionally present as complicated disease with severe perianal pain driving increasingly intensive medical therapy despite well controlled luminal disease. We identified a regional cohort of prospectively acquired incident cases of paediatric CD diagnosed <16 years of age in South-East Scotland over a 19-year period (1999–2018), and conducted a retrospective review of complicated fissuring perianal CD causing severe pain related to anal sphincter complex spasm at defecation. Two hundred forty-seven new cases of paediatric CD were diagnosed with complicated fissuring perianal disease identified in 4 described cases (cumulative incidence 1.6%). These patients with marked fissuring and refractory anal sphincter complex spasm required neurostimulation-guided, 4-quadrant, anal intrasphincteric botulinum toxin (BT). All experienced immediate success, measured by cessation of spasms, with variable ongoing symptom relief after median (range) 3 (2–5) BT injections.