ORLANDO — About 25% of children newly diagnosed with Crohn's disease will develop perianal fistulas within 2 years, but the majority of these fistulas will resolve in response to medical management alone, Dr. David J. Keljo reported at a poster session at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Using data from a prospective, observational registry that enrolled pediatric patients with irritable bowel disease (IBD), investigators assessed outcomes for 263 children under age 16 years newly diagnosed with Crohn's disease. All participants had at least 24 months of follow-up.
Dr. Keljo and his associates from the Pediatric IBD Collaborative Research Group in Hartford, Conn., studied the frequency and clinical course of perianal fistulas in these children. Roughly 25% had fistulas within the first 2 years, and three-quarters of the latter children had them within the first 30 days.
Fistulizing patients were more likely than nonfistulizing patients to be treated with infliximab, 6MP/AZA6 [mercaptopurine (6MP) and its prodrug azathioprine (AZA)], methotrexate, and antibiotics.
A total of 47 children (18%) had fistulas by day 30 after diagnosis. Of these, fistulas resolved in 35 (75%) patients, including 7 whose fistulas resolved after infliximab therapy. None required surgery, said Dr. Keljo, who is on the pediatric gastroenterology staff at Children's Hospital of Pittsburgh. Another 18 patients (7%) developed lesions after 30 days but before 2 years.