SynthesisTechniques in coloproctology2025
Early diagnosis of Crohn's disease in patients presenting with a perianal fistula: systematic review and development of a perianal red flags index.
Synthesis in Techniques in coloproctology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Impaired keratinization activity in perianal Crohn's fistulas is associated with poor prognosis.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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10 authors.
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Abstract
backgroundDelay in diagnosing Crohn's disease (CD) in patients presenting with perianal abscess (PAA) and/or fistula (PAF) is common. The aim of this study was to identify red flags suggestive of CD.
methodsA systematic literature review was conducted to identify symptoms associated with CD in patients presenting with PAA/PAF. A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012-2023) at a single non-academic teaching hospital. All patients were asked to recall symptoms/signs experienced during their first PAF.
resultsThe systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (n = 2)/PAF (n = 6), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72-0.94]).
conclusionsThe perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.
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