The following is a summary of “Predictors of Perianal Fistula Healing in Children With Newly Diagnosed Crohn Disease” published in the December 2022 issue of Pediatric Gastroenterology and Nutrition by Singer et al.
There is a lack of information on the long-term effects of perianal fistulas in children, even though they are among the most serious consequences of Crohn’s disease. The goal was to examine newly diagnosed pediatric Crohn’s disease patients to identify factors that predict the successful closure of perianal fistulas. Patients with perianal fistulas due to Crohn’s disease were tracked from the time of diagnosis through the time when the fistula healed in this retrospective study conducted at a single center. Cox proportional hazard regression models were used to analyze the time it took for patients to recover from perianal surgical procedures like fistulotomy, fistulectomy, removal of perianal lesions, seton placement, and incision and drainage. Relevant covariates included patient demographics, disease characteristics, medical therapies [no anti-tumor necrosis factor (TNF)α therapy, anti-TNFα therapy therapeutic drug monitoring], and the presence or absence of anti-TNFα.
Among the 485 people diagnosed with Crohn’s disease, 107 (or 22%) already had a perianal fistula. Delayed fistula healing was linked to non-White race (hazard ratio [HR] 0.30, P<0.01), male sex (HR 0.42, P=0.02), and perianal fistulotomy, fistulectomy, and lesion excision [HR 0.46; P=0.028]. Treatment with anti-TNFα while using therapeutic drug monitoring was related to quicker fistula repair (HR 1.78, P=0.009). In addition, therapy did not influence recovery in any other way.
Non-White race and the use of fistulotomy, fistulectomy, or the excision of a perianal lesion were also linked to a lengthened recovery time for the fistula. When compared to all other medical treatment groups, including those receiving anti-TNFα therapy without therapeutic drug monitoring, those receiving anti-TNFα therapy in combination with therapeutic drug monitoring experienced much faster fistula repair.