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Anal ulcerations in Crohn's disease: Natural history in the era of biological therapy

Abstract : Background - The natural history of anal ulcerations in Crohn's disease remains unknown. Aims - To assess the long-term outcomes of anorectal ulcerations. Methods - Data from consecutive patients with perineal Crohn's disease were prospectively recorded. The data of patients with anal ulceration were extracted. Results - Anal ulcerations were observed in 154 of 282 patients (54.6%), and 77 cases involved cavitating ulcerations. The cumulative healing rates were 47%, 70% and 82% at 1, 2 and 3 years, respectively. Patients with a primary fistula phenotype had a shorter median time to healing of their anal ulceration (28 [13-83] weeks) than those with a stricture (81 [28-135] weeks) or those with isolated ulceration (74 [31-181] weeks) (p=0.004). Among patients with ulcerations but no fistula at referral (n=67), only 4 (6%) developed de novo abscesses and/or fistula during follow-up. There was no benefit associated with introducing or optimising biologics, nor with combining immunosuppressants and biologics. Conclusion - Anal ulceration in Crohn's disease usually requires a long time to achieve sustained healing. Determining the impact of biologics on healing rates will require dedicated randomised trials although it does not show a significant healing benefit in the present study.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01637192
Contributor : Laurent Jonchère <>
Submitted on : Friday, November 17, 2017 - 1:58:52 PM
Last modification on : Tuesday, February 25, 2020 - 9:20:36 AM

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T. Wallenhorst, C. Brochard, E. Le Balch, A. Bodere, A. Garros, et al.. Anal ulcerations in Crohn's disease: Natural history in the era of biological therapy. Digestive and Liver Disease, WB Saunders, 2017, 49 (11), pp.1191-1195. ⟨10.1016/j.dld.2017.07.014⟩. ⟨hal-01637192⟩

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