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Recognising and treating complicated fissuring perianal Crohn’s Disease: a South-East Scotland cohort study

Burgess, Christopher J; Clark, Claire; Khedim, Cher-Antonia; Armstrong, Katherine; Wilson, David C; Henderson, Paul

Authors

Christopher J Burgess

Claire Clark

Katherine Armstrong

David C Wilson

Paul Henderson



Abstract

Fissuring perianal Crohn's 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. 247 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, four quadrant, anal intrasphincteric botulinum toxin. All experienced immediate success, measured by cessation of spasms, with variable ongoing symptom relief after median (range) 3 (2-5) BT injections.

Citation

Burgess, C. J., Clark, C., Khedim, C., Armstrong, K., Wilson, D. . C., & Henderson, P. (2022). Recognising and treating complicated fissuring perianal Crohn’s Disease: a South-East Scotland cohort study. Journal of Pediatric Gastroenterology and Nutrition, 74(1), 68-71. https://doi.org/10.1097/MPG.0000000000003285

Journal Article Type Article
Acceptance Date Jul 18, 2021
Online Publication Date Aug 12, 2021
Publication Date 2022-01
Deposit Date Sep 1, 2021
Publicly Available Date Mar 29, 2024
Journal Journal of Pediatric Gastroenterology & Nutrition
Print ISSN 0277-2116
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 74
Issue 1
Pages 68-71
DOI https://doi.org/10.1097/MPG.0000000000003285
Keywords anal fissure, Crohn disease, epidemiology, inflammatory bowel disease, paediatric
Public URL http://researchrepository.napier.ac.uk/Output/2797196

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Recognising And Treating Complicated Fissuring Perianal Crohn’s Disease: A South-East Scotland Cohort Study (accepted version) (275 Kb)
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