L J Munster, G R Meriba, J Schuitema, S van Dieren, E J de Groof, M W Mundt, G R D'Haens, W A Bemelman, C J Buskens, J D W van der Bilt
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A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012-2023) at a single non-academic teaching hospital. All patients were asked to recall symptoms/signs experienced during their first PAF.</p><p><strong>Results: </strong>The systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (n = 2)/PAF (n = 6), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72-0.94]).</p><p><strong>Conclusions: </strong>The perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"89"},"PeriodicalIF":2.9000,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953225/pdf/","citationCount":"0","resultStr":"{\"title\":\"Early diagnosis of Crohn's disease in patients presenting with a perianal fistula: systematic review and development of a perianal red flags index.\",\"authors\":\"L J Munster, G R Meriba, J Schuitema, S van Dieren, E J de Groof, M W Mundt, G R D'Haens, W A Bemelman, C J Buskens, J D W van der Bilt\",\"doi\":\"10.1007/s10151-024-03106-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Delay in diagnosing Crohn's disease (CD) in patients presenting with perianal abscess (PAA) and/or fistula (PAF) is common. 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A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). 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引用次数: 0
摘要
背景：以肛周脓肿（PAA）和/或瘘管（PAF）为表现的克罗恩病（CD）的诊断延迟是常见的。本研究的目的是识别提示CD的危险信号。方法：进行了系统的文献综述，以确定PAA/PAF患者与CD相关的症状。一份包括这些症状的调查问卷，补充了国际炎症性肠病研究组织（International Organization for the Study of Inflammatory Bowel Diseases, IO-IBD）管腔性CD红旗指数的项目，在一家非学术教学医院对所有出现PAF并最终诊断为CD的成年患者和来自同一研究期间患有隐腺性PAF（2012-2023）的匹配患者（1:3）进行了管理。所有患者被要求回忆他们第一次PAF期间经历的症状/体征。结果：系统评价确定了8篇文章，报道了PAA (n = 2)/PAF （n = 6）患者的15个临床特征，并补充了IO-IBD红旗指数中的13个项目（共28个项目）。共有25例CD患者和75例PAF无CD患者回答了问卷。单因素分析确定了与CD相关的7个项目（年龄、家族史、> 2肛周干预、体重减轻、腹痛、腹泻和疲劳），4个项目在多因素分析中仍然具有显著性：年龄（OR 3.4[1.0-11.5]）、> 2既往肛周干预（OR 3.4[1.0-10.1]）、体重减轻（OR 14.4[3.7-55.6]）和腹痛（OR 9.8[1.9-49.8]）。受试者工作特征曲线（ROC）分析显示，这些危险信号的组合与良好的CD与非CD区分相关（AUC为0.83[0.72-0.94]）。结论:肛周的红旗指数具有良好的预测价值拥堵的患者早期识别潜在的风险CD。
Early diagnosis of Crohn's disease in patients presenting with a perianal fistula: systematic review and development of a perianal red flags index.
Background: Delay in diagnosing Crohn's disease (CD) in patients presenting with perianal abscess (PAA) and/or fistula (PAF) is common. The aim of this study was to identify red flags suggestive of CD.
Methods: A systematic literature review was conducted to identify symptoms associated with CD in patients presenting with PAA/PAF. A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012-2023) at a single non-academic teaching hospital. All patients were asked to recall symptoms/signs experienced during their first PAF.
Results: The systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (n = 2)/PAF (n = 6), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72-0.94]).
Conclusions: The perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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