ArticleJournal of Crohn's & colitis2025
Prolonged Time to Diagnosis of Crohn's Disease in Patients With Perianal Fistulas Negatively Affects Long-Term Outcomes.
Article in Journal of Crohn's & colitis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Impaired keratinization activity in perianal Crohn's fistulas is associated with poor prognosis.Journal of Crohn's & colitis · 2026Article
- Multiomics analysis dissects the molecular foundation of perianal fistulas associated with Crohn's disease and of cryptoglandular origin.Journal of Crohn's & colitis · 2026Article
- Prediction tool for early identification of patients at risk of Crohn's disease in perianal fistulas and abscesses (PREFAB): Analysis of a prospective pilot study at a non-academic, teaching centre in the Netherlands.Techniques in coloproctology · 2025Article
- Diagnosing Crohn's disease in presumed cryptoglandular perianal fistulas: an expert Delphi consensus on early identification of patients at risk of Crohn's disease in perianal fistulas (PREFAB).Journal of Crohn's & colitis · 2025Article
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Authors and funding
7 authors.
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Abstract
BACKGROUND AND
aimThis study aims to evaluate the effect of time to Crohn's disease (CD) diagnosis on perianal fistula (PAF) outcomes in patients with a fistula as the first manifesting sign.
methodsIn this multicenter, retrospective study, CD patients with a PAF preceding CD diagnosis between November 2015 and June 2022 were included. The primary outcome parameter was the time to CD diagnosis and its correlation with long-term outcomes.
resultsIn total, 126 patients with a PAF prior to CD diagnosis were identified. The median time to CD diagnosis was 15.0 months (IQR 3.8-47.3). A total of 49 patients (38.9%) had a clinically closed fistula of which 21 patients (42.9%) achieved radiological healing. Twenty-five patients (19.8%) underwent defunctioning, of which 9 patients (36.0%) needed proctectomy. Median time to CD diagnosis was shortest in patients with radiological healing (4.0 months, IQR 2.0-16.5) or clinical closure without radiological healing (11.0 months, IQR 3.0-47.8). In patients without fistula closure (n = 51), the median time to CD diagnosis was significantly longer compared to patients with fistula closure, 18.0 months vs 8.0 months (p = 0.031). In patients who needed defunctioning, the median time to diagnosis was more than twice as long compared to patients without defunctioning, 30.0 months vs 12.0 months (p = 0.054).
conclusionA prolonged time to CD diagnosis in patients with a PAF as a manifesting sign is associated with worse long-term outcomes. Patients in whom radiological healing could be achieved had the shortest time to CD diagnosis, emphasizing the relevance of increased clinical awareness of underlying CD in fistula patients.
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