Predictive Factors of a New Episode of Suppuration after Remission of Fistulizing Ano Perineal Crohn's Disease: A Moroccan Series

Abstract

Fistulizing ano-perineal lesions occur in more than 20% of patients with Crohn's disease (CD). Although many medical and surgical treatments are now available, the relapse rate of such lesions remains high at nearly 30%. The objective of this study was to identify factors predictive of a new episode of anal suppuration in patients with fistulizing ano-perineal CD initially put into remission. This was a retrospective single-center study that included between 2018 and 2022 all patients with CD complicated by ano-perineal fistula put into remission. Achievement of remission was defined by the absence of new suppuration within 3 months of the last drainage surgery. Fifty-seven patients (57% female; median age at drainage 31 years) with multiple episodes of suppuration were included consecutively during the period. The rate of new ano-perineal suppuration was 22%, which occurred within a median of 1.8 years. Actuarially, survival without new suppuration was 96.7% at 1 year, 78.4% at 3 years, and 74.4% at 5 years. In the 38 (66.6%) patients receiving anti-TNF therapy after drainage, colonic (OR 1.25, p = 0.015) or ileocolic (OR 5.16, p = 0.015) location of CD, stenosing luminal phenotype (OR 5. 32, p = 0.013) and discontinuation of anti-TNF therapy during follow-up (OR 3.37, p = 0.049) were associated with an increased risk of a new suppurative episode in multivariate analysis. Conversely, discontinuation of conventional immunosuppressive therapy was associated with a reduced risk of a new episode of suppuration (OR 0.22, p = 0.29).