Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn’s Disease: A Population-based Study
Authors: Danielou Marie , Sarter Hélène , Pariente Benjamin , Fumery Mathurin , Ley Delphine , Mamona Christel , Barthoulot Maël , Charpentier Cloé , Siproudhis Laurent , Savoye Guillaume , Gower-Rousseau Corinne ,   EPIMAD Group, Andre J M , Antonietti M , Aouakli A , Armand A , Aroichane I , Assi F , Aubet J P , Auxenfants E , Ayafi-Ramelot F , Azzouzi K , Bankovski D , Barbry B , Bardoux N , Baron P , Baudet A , Bazin B , Bebahani A , Becqwort J P , Benet V , Benali H , Benguigui C , Ben Soussan E , Bental A , Berkelmans I , Bernet J , Bernou K , Bernou-Dron C , Bertot P , Bertiaux-Vandaële N , Bertrand V , Billoud E , Biron N , Bismuth B , Bleuet M , Blondel F , Blondin V , Bohon P , Boniface E , Bonnière P , Bonvarlet E , Bonvarlet P , Boruchowicz A , Bostvironnois R , Boualit M , Bouche B , Boudaillez C , Bourgeaux C , Bourgeois M , Bourguet A , Bourienne A , Branche J , Bray G , Brazier F , Breban P , Bridenne M , Brihier H , Brung-Lefebvre V , Bulois P , Burgiere P , Butel J , Canva J Y , Canva-Delcambre V , Capron J P , Cardot F , Carpentier P , Cartier E , Cassar J F , Cassagnou M , Castex J F , Catala P , Cattan S , Catteau S , Caujolle B , Cayron G , Chandelier C , Chantre M , Charles J , Charneau T , Chavance-Thelu M , Chirita D , Choteau A , Claerbout J F , Clergue P Y , Coevoet H , Cohen G , Collet R , Colombel J F , Coopman S , Corvisart J , Cortot A , Couttenier F , Crinquette J F , Crombe V , Dadamessi I , Dapvril V , Davion T , Dautreme S , Debas J , Degrave N , Dehont F , Delatre C , Delcenserie R , Delette O , Delgrange T , Delhoustal L , Delmotte J S , Demmane S , Deregnaucourt G , Descombes P , Desechalliers J P , Desmet P , Desreumaux P , Desseaux G , Desurmont P , Devienne A , Devouge E , Devred M , Devroux A , Dewailly A , Dharancy S , Di Fiore A , Djeddi D , Djedir R , Dreher-Duwat M L , Dubois R , Dubuque C , Ducatillon P , Duclay J , Ducrocq B , Ducrot F , Ducrotte P , Dufilho A , Duhamel C , Dujardin D , Dumant-Forest C , Dupas J L , Dupont F , Duranton Y , Duriez A , El Achkar K , El Farisi M , Elie C , Elie-Legrand M C , Elkhaki A , Eoche M , Evrard D , Evrard J P , Fatome A , Filoche B , Finet L , Flahaut M , Flamme C , Foissey D , Fournier P , Foutrein-Comes M C , Foutrein P , Fremond D , Frere T , Fumery M , Gallet P , Gamblin C , Ganga S , Gerard R , Geslin G , Gheyssens Y , Ghossini N , Ghrib S , Gilbert T , Gillet B , Godard D , Godard P , Godchaux J M , Godchaux R , Goegebeur G , Goria O , Gottrand F , Gower P , Grandmaison B , Groux M , Guedon C , Guillard J F , Guillem L , Guillemot F , Guimberd D , Haddouche B , Hakim S , Hanon D , Hautefeuille V , Heckestweiller P , Hecquet G , Hedde J P , Hellal H , Henneresse P E , Heyman B , Heraud M , Herve S , Hochain P , Houssin-Bailly L , Houcke P , Huguenin B , Iobagiu S , Ivanovic A , Iwanicki-Caron I , Janicki E , Jarry M , Jeu J , Joly J P , Jonas C , Katherin F , Kerleveo A , Khachfe A , Kiriakos A , Kiriakos J , Klein O , Kohut M , Kornhauser R , Koutsomanis D , Laberenne J E , Laffineur G , Lagarde M , Lalanne A , Lannoy P , Lapchin J , Laprand M , Laude D , Leblanc R , Lecieux P , Leclerc N , Le Couteulx C , Ledent J , Lefebvre J , Lefiliatre P , Legrand C , Le Grix A , Lelong P , Leluyer B , Lenaerts C , Lepileur L , Leplat A , Lepoutre-Dujardin E , Leroi H , Leroy M Y , Lesage J P , Lesage X , Lesage J , Lescanne-Darchis I , Lescut J , Lescut D , Leurent B , Levy P , Lhermie M , Lion A , Lisambert B , Loire F , Louf S , Louvet A , Luciani M , Lucidarme D , Lugand J , Macaigne O , Maetz D , Maillard D , Mancheron H , Manolache O , Marks-Brunel A B , Marti R , Martin F , Martin G , Marzloff E , Mathurin P , Mauillon J , Maunoury V , Maupas J L , Mesnard B , Metayer P , Methari L , Meurisse B , Meurisse F , Michaud L , Mirmaran X , Modaine P , Monthe A , Morel L , Mortier P E , Moulin E , Mouterde O , Mudry J , Nachury M , N’Guyen Khac E , Notteghem B , Ollevier V , Ostyn A , Ouraghi A , Ouvry D , Paillot B , Panien-Claudot N , Paoletti C , Papazian A , Parent B , Pariente B , Paris J C , Patrier P , Paupart L , Pauwels B , Pauwels M , Petit R , Piat M , Piotte S , Plane C , Plouvier B , Pollet E , Pommelet P , Pop D , Pordes C , Pouchain G , Prades P , Prevost A , Prevost J C , Quesnel B , Queuniet A M , Quinton J F , Rabache A , Rabelle P , Raclot G , Ratajczyk S , Rault D , Razemon V , Reix N , Revillon M , Richez C , Robinson P , Rodriguez J , Roger J , Roux J M , Rudelli A , Saber A , Savoye G , Schlosseberg P , Segrestin M , Seguy D , Serin M , Seryer A , Sevenet F , Shekh N , Silvie J , Simon V , Spyckerelle C , Talbodec N , Techy A , Thelu J L , Thevenin A , Thiebault H , Thomas J , Thorel J M , Tielman G , Tode M , Toisin J , Tonnel J , Touchais J Y , Touze Y , Tranvouez J L , Triplet C , Turck D , Uhlen S , Vaillant E , Valmage C , Vanco D , Vandamme H , Vanderbecq E , Vander Eecken E , Vandermolen P , Vandevenne P , Vandeville L , Vandewalle A , Vandewalle C , Vaneslander P , Vanhoove J P , Vanrenterghem A , Varlet P , Vasies I , Verbiese G , Vernier-Massouille G , Vermelle P , Verne C , Vezilier-Cocq P , Vigneron B , Vincendet M , Viot J , Voiment Y M , Wacrenier A , Waeghemaecker L , Wallez J Y , Wantiez M , Wartel F , Weber J , Willocquet J L , Wizla N , Wolschies E , Zalar A , Zaouri B , Zellweger A , Ziade C 
Published: October 2019

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 &lt; 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.