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Prevalence of anal fistula in the United Kingdom

World Journal of Clinical Cases 2019年第14期7卷 1795-1804页

作者： Suvi RK Hokkanen Naomi Boxall Javaria Mona Khalid Dimitri Bennett haridarshan patel Real World Evidence Solutions IQVIALondon N19JYUnited Kingdom Evidence and Value Generation Global Medical AffairsTakeda Pharmaceuticals International Inc.London WC2B 4AEUnited Kingdom Department of Epidemiology Takeda Pharmaceuticals International Inc.CambridgeMA 02139United StatesAdjunctPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA 19104United States Evidence and Value Generation Global Medical AffairsTakeda Pharmaceuticals International Inc.DeerfieldIL 6001United States

BACKGROUND Anal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated. AIM To assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe. METHODS A retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported. RESULTS The United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44;95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients wi

关键词： Anal fistula United Kingdom Europe Crohn's disease Comorbidities Prevalence

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Burden and outcomes for complex perianal fistulas in Crohn's disease:Systematic review

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World Journal of Gastroenterology 2018年第42期24卷 4821-4834页

作者： Julian Panes Walter Reinisch Ewa Rupniewska Shahnaz Khan Joan Forns Javaria Mona Khalid Daniela Bojic haridarshan patel Department of Gastroenterology Hospital Clínic de BarcelonaIDIBAPSCIBERehdBarcelona 08036Spain Medical University of Vienna Vienna 1090Austria RTI Health Solutions Manchester M20 2LSUnited Kingdom RTI Health Solutions Research Triangle ParkNC 27709United States RTI Health Solutions Barcelona 08028Spain Takeda DeerfieldIL 60015United States

AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal *** PubMed, Embase, and Cochrane were searched for relevant articles(published 2000-November 2016) and congress abstracts(published 2011-November 2016).RESULTS Of 535 records reviewed, 62 relevant sources were identified(mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14%(follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment(failure and relapse rates,respectively: medical, 12%-73% and 0%-41%; surgical:0%-100% and 11%.20%; combined medical/surgical:0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies(1 of infliximab; 3 of surgical interventions)have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in *** Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to antitumour necrosis factor-α agents, as evidenced by high failure and relapse rates.

关键词： Burden Complex perianal fistulas Crohn’s disease Epidemiology Outcomes Systematic literature review Treatment

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