Natural History of Perianal Fistulising Lesions in Patients with Elderly-onset Crohn's Disease: A Population-based Study

Marie Danielou, Hélène Sarter, Benjamin Pariente, Mathurin Fumery, Delphine Ley, Christel Mamona, Maël Barthoulot, Cloé Charpentier, Laurent Siproudhis, Guillaume Savoye, Corinne Gower-Rousseau, J. M. Andre, M. Antonietti, A. Aouakli, A. Armand, I. Aroichane, F. Assi, J. P. Aubet, E. Auxenfants, F. Ayafi-RamelotK. Azzouzi, D. Bankovski, B. Barbry, N. Bardoux, P. Baron, A. Baudet, B. Bazin, A. Bebahani, J. P. Becqwort, V. Benet, H. Benali, C. Benguigui, E. Ben Soussan, A. Bental, I. Berkelmans, J. Bernet, K. Bernou, C. Bernou-Dron, P. Bertot, N. Bertiaux-Vandaële, V. Bertrand, E. Billoud, N. Biron, B. Bismuth, M. Bleuet, F. Blondel, V. Blondin, P. Bohon, E. Boniface, P. Bonnière, E. Bonvarlet, P. Bonvarlet, A. Boruchowicz, R. Bostvironnois, M. Boualit, B. Bouche, C. Boudaillez, C. Bourgeaux, M. Bourgeois, A. Bourguet, A. Bourienne, J. Branche, G. Bray, F. Brazier, P. Breban, M. Bridenne, H. Brihier, V. Brung-Lefebvre, P. Bulois, P. Burgiere, J. Butel, J. Y. Canva, V. Canva-Delcambre, J. P. Capron, F. Cardot, P. Carpentier, E. Cartier, J. F. Cassar, M. Cassagnou, J. F. Castex, P. Catala, S. Cattan, S. Catteau, B. Caujolle, G. Cayron, C. Chandelier, M. Chantre, J. Charles, T. Charneau, M. Chavance-Thelu, D. Chirita, A. Choteau, J. F. Claerbout, P. Y. Clergue, H. Coevoet, G. Cohen, R. Collet, J. F. Colombel, S. Coopman, J. Corvisart, A. Cortot, F. Couttenier, J. F. Crinquette, V. Crombe, I. Dadamessi, V. Dapvril, T. Davion, S. Dautreme, J. Debas, N. Degrave, F. Dehont, C. Delatre, R. Delcenserie, O. Delette, T. Delgrange, L. Delhoustal, J. S. Delmotte, S. Demmane, G. Deregnaucourt, P. Descombes, J. P. Desechalliers, P. Desmet, P. Desreumaux, G. Desseaux, P. Desurmont, A. Devienne, E. Devouge, M. Devred, A. Devroux, A. Dewailly, S. Dharancy, A. Di Fiore, D. Djeddi, R. Djedir, M. L. Dreher-Duwat, R. Dubois, C. Dubuque, P. Ducatillon, J. Duclay, B. Ducrocq, F. Ducrot, P. Ducrotte, A. Dufilho, C. Duhamel, D. Dujardin, C. Dumant-Forest, J. L. Dupas, F. Dupont, Y. Duranton, A. Duriez, K. El Achkar, M. El Farisi, C. Elie, M. C. Elie-Legrand, A. Elkhaki, M. Eoche, D. Evrard, J. P. Evrard, A. Fatome, B. Filoche, L. Finet, M. Flahaut, C. Flamme, D. Foissey, P. Fournier, M. C. Foutrein-Comes, P. Foutrein, D. Fremond, T. Frere, M. Fumery, P. Gallet, C. Gamblin, S. Ganga, R. Gerard, G. Geslin, Y. Gheyssens, N. Ghossini, S. Ghrib, T. Gilbert, B. Gillet, D. Godard, P. Godard, J. M. Godchaux, R. Godchaux, G. Goegebeur, O. Goria, F. Gottrand, P. Gower, B. Grandmaison, M. Groux, C. Guedon, J. F. Guillard, L. Guillem, F. Guillemot, D. Guimberd, B. Haddouche, S. Hakim, D. Hanon, V. Hautefeuille, P. Heckestweiller, G. Hecquet, J. P. Hedde, H. Hellal, P. E. Henneresse, B. Heyman, M. Heraud, S. Herve, P. Hochain, L. Houssin-Bailly, P. Houcke, B. Huguenin, S. Iobagiu, A. Ivanovic, I. Iwanicki-Caron, E. Janicki, M. Jarry, J. Jeu, J. P. Joly, C. Jonas, F. Katherin, A. Kerleveo, A. Khachfe, A. Kiriakos, J. Kiriakos, O. Klein, M. Kohut, R. Kornhauser, D. Koutsomanis, J. E. Laberenne, G. Laffineur, M. Lagarde, A. Lalanne, P. Lannoy, J. Lapchin, M. Laprand, D. Laude, R. Leblanc, P. Lecieux, N. Leclerc, C. Le Couteulx, J. Ledent, J. Lefebvre, P. Lefiliatre, C. Legrand, A. Le Grix, P. Lelong, B. Leluyer, C. Lenaerts, L. Lepileur, A. Leplat, E. Lepoutre-Dujardin, H. Leroi, M. Y. Leroy, J. P. Lesage, X. Lesage, J. Lesage, I. Lescanne-Darchis, J. Lescut, D. Lescut, B. Leurent, P. Levy, M. Lhermie, A. Lion, B. Lisambert, F. Loire, S. Louf, A. Louvet, M. Luciani, D. Lucidarme, J. Lugand, O. MacAigne, D. Maetz, D. Maillard, H. Mancheron, O. Manolache, A. B. Marks-Brunel, R. Marti, F. Martin, G. Martin, E. Marzloff, P. Mathurin, J. Mauillon, V. Maunoury, J. L. Maupas, B. Mesnard, P. Metayer, L. Methari, B. Meurisse, F. Meurisse, L. Michaud, X. Mirmaran, P. Modaine, A. Monthe, L. Morel, P. E. Mortier, E. Moulin, O. Mouterde, J. Mudry, M. Nachury, E. N'Guyen Khac, B. Notteghem, V. Ollevier, A. Ostyn, A. Ouraghi, D. Ouvry, B. Paillot, N. Panien-Claudot, C. Paoletti, A. Papazian, B. Parent, B. Pariente, J. C. Paris, P. Patrier, L. Paupart, B. Pauwels, M. Pauwels, R. Petit, M. Piat, S. Piotte, C. Plane, B. Plouvier, E. Pollet, P. Pommelet, D. Pop, C. Pordes, G. Pouchain, P. Prades, A. Prevost, J. C. Prevost, B. Quesnel, A. M. Queuniet, J. F. Quinton, A. Rabache, P. Rabelle, G. Raclot, S. Ratajczyk, D. Rault, V. Razemon, N. Reix, M. Revillon, C. Richez, P. Robinson, J. Rodriguez, J. Roger, J. M. Roux, A. Rudelli, A. Saber, G. Savoye, P. Schlosseberg, M. Segrestin, D. Seguy, M. Serin, A. Seryer, F. Sevenet, N. Shekh, J. Silvie, V. Simon, C. Spyckerelle, N. Talbodec, A. Techy, J. L. Thelu, A. Thevenin, H. Thiebault, J. Thomas, J. M. Thorel, G. Tielman, M. Tode, J. Toisin, J. Tonnel, J. Y. Touchais, Y. Touze, J. L. Tranvouez, C. Triplet, D. Turck, S. Uhlen, E. Vaillant, C. Valmage, D. Vanco, H. Vandamme, E. Vanderbecq, E. Vander Eecken, P. Vandermolen, P. Vandevenne, L. Vandeville, A. Vandewalle, C. Vandewalle, P. Vaneslander, J. P. Vanhoove, A. Vanrenterghem, P. Varlet, I. Vasies, G. Verbiese, G. Vernier-Massouille, P. Vermelle, C. Verne, P. Vezilier-Cocq, B. Vigneron, M. Vincendet, J. Viot, Y. M. Voiment, A. Wacrenier, L. Waeghemaecker, J. Y. Wallez, M. Wantiez, F. Wartel, J. Weber, J. L. Willocquet, N. Wizla, E. Wolschies, A. Zalar, B. Zaouri, A. Zellweger, C. Ziade

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Introduction: Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD. Method: All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD. Results: A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up. Conclusion: During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

Original languageEnglish
Pages (from-to)501-507
Number of pages7
JournalJournal of Crohn's and Colitis
Volume14
Issue number4
DOIs
StatePublished - 21 May 2020

Keywords

  • Elderly-onset Crohn's disease
  • epidemiology
  • natural history
  • perianal disease
  • treatment

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