Prevalence of Anal Fistulas in Europe: Systematic Literature Reviews and Population-Based Database Analysis

Garcı́a-Olmo, Damián; Assche, Gert Van; Tagarro, Ignacio; Díez, Mary Carmen; Richard, M; Khalid, Javaria Mona; Dijk, Marc van; Bennett, Dimitri; Hokkanen, Suvi R. K.; Panés, Julián

doi:10.1007/s12325-019-01117-y

Cited by 44 publications

(37 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most anal fistula patients identified in this study were idiopathic. This finding is consistent with previous studies[4,31,32] and a recently conducted systematic literature review on anal fistula prevalence[8]. As the fistula duration is longer for patients with CD than for patients without[33-36], we adjusted the look-back period for prevalence estimates accordingly, which allowed for accurate prevalence estimate.…”

Section: Discussionsupporting

confidence: 87%

“…Reported population-based incidence estimates for anal fistula in CD patients range between 1.2%[37] to 7.5%[38]. Based on these values, a systematic review calculated anal fistula prevalence among CD patients to be 3.4%-6.0% in the Europe[8]. Our study’s prevalence estimates of anal fistula patients with CD (0.44/10000 patients, United Kingdom standardized) are not directly comparable to these results, as the denominators represent different patient populations (we used the number of total patients instead of number of CD patients).…”

Section: Discussionmentioning

confidence: 99%

“…However, being more than 10 years old, these reports may be outdated. A recent systematic review estimates the prevalence of anal fistula in Europe as 1.69 per 10000 patients[8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of anal fistula in the United Kingdom

Hokkanen

Boxall

Khalid

et al. 2019

WJCC

Self Cite

View full text Add to dashboard Cite

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is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated.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 without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare. CONCLUSION This real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of anal fistula in the United Kingdom

Hokkanen

Boxall

Khalid

et al. 2019

WJCC

Self Cite

View full text Add to dashboard Cite

show abstract

“…There are 20,000 to 25,000 newly confirmed cases in the USA each year ( 1 ). A statistical analysis based on a large population database in the UK showed that the incidence of anal fistula is 1.69 cases per 10,000 individuals ( 2 ). This was also evidenced by other relevant studies ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Advances in the Treatment of Anal Fistula: A Mini-Review of Recent Five-Year Clinical Studies

Zhang

et al. 2021

Front. Surg.

View full text Add to dashboard Cite

Anal fistula, with its complicated pathogenesis, has been considered as a clinical challenge for centuries. The risk of frequent recurrence and incontinence constitutes a considerable threat in the long-term treatment of anal fistula. In this work, we narratively reviewed the scientific literature of new techniques that have been used for anal fistula treatment over the recent 5 years, objectively evaluated the pros and cons of each technique on the basis of clinical outcomes, and tried to disclose the effective strategies for anal fistula treatment. Up to date, surgery is the main method used for treating anal fistula, but there is no simple technique that can completely heal complex anal fistula. In the course of surgery treatment, the healing outcome, and the protection of anal function should be weighed comprehensively. Among the innovative techniques that have emerged in recent years, combined techniques based on drainage Seton and LIFT-plug seem to be the relatively effective therapies, but their effectiveness requires more multi-center prospective randomized controlled trials with large sample size and long-term follow-up to be validated.

show abstract

“…The cumulative incidence of perianal fistulas among CD patients in the US is approximately 10% at 1 year after diagnosis, 15% at 5 years, 18% at 10 years, 23% at 20 years, and 24% at 30 years [ 2 , 4 ]. The overall prevalence of perianal fistulas in Europe, estimated as the sum of the estimated prevalence for all etiologies, was 1.69/10,000 population [ 5 ]. In a multicenter study in Korea, 35% of CD patients had a history of perianal fistula, while 28% had concomitant perianal fistulas at the time of the CD diagnosis [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View

Lee

Yoon

2021

Ann Coloproctol

View full text Add to dashboard Cite

Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

show abstract

Prevalence of Anal Fistulas in Europe: Systematic Literature Reviews and Population-Based Database Analysis

Cited by 44 publications

References 52 publications

Prevalence of anal fistula in the United Kingdom

Prevalence of anal fistula in the United Kingdom

Advances in the Treatment of Anal Fistula: A Mini-Review of Recent Five-Year Clinical Studies

Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View

Contact Info

Product

Resources

About