The cryptoglandular theory revisited

Gosselink, M.; Onkelen, Robbert S. van; Schouten, W. R.

doi:10.1111/codi.13161

Cited by 38 publications

(29 citation statements)

References 15 publications

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“…An anal (or perianal) fistula is defined as an external abnormal anatomical connection between the anorectal canal and the perianal skin[1]. Symptoms of anal fistulas include perianal cellulitis, anorectal pain, pruritus ani, smelly or bloody drainage of pus, and in some cases difficulty controlling bowel movements[2,3].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of anal fistula in the United Kingdom

Hokkanen

Boxall

Khalid

et al. 2019

WJCC

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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is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated.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.

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Section: Introductionmentioning

confidence: 99%

“…Most anal fistulas are idiopathic (approximately 90% of cases), and arise from an infected anal crypt[1]. Men are more commonly affected than women[4], and the mean age of first presentation is reported to be 40 years[5].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of anal fistula in the United Kingdom

Hokkanen

Boxall

Khalid

et al. 2019

WJCC

View full text Add to dashboard Cite

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“…Perianal fistulas are tracts that connect the intestinal lumen, usually the anal canal or rectum, with the perianal skin. 1 Cryptoglandular (CG) perianal fistulas occur in patients without Crohn's disease (CD) and are caused by an infected perianal crypt gland. The incidence of CG perianal fistulas in Europe is reported to be around 2 per 10,000 per year.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of faecal calprotectin in patients with active perianal fistulas

et al. 2019

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Background Faecal calprotectin (FC) is a marker of mucosal inflammation. Objective The aim of this study was to determine the diagnostic accuracy of FC to (a) differentiate between perianal fistulizing Crohn's disease (pCD) and cryptoglandular perianal fistulas; and (b) detect mucosal inflammation in pCD. Methods Patients with active perianal fistulas who had FC measured and a complete ileocolonoscopy within 10 weeks were retrospectively included. Results Fifty-six patients were included (pCD, n = 37) of whom 19 pCD patients exhibited ulcers. FC was significantly higher in pCD compared to cryptoglandular fistulas (µg/g) (708.0 (207.0–1705.0) vs 32.0 (23.0–77.0), p < 0.001). Area-under-the-curve (AUC) value for FC receiver operating characteristic (ROC) statistics was 0.900. Optimal FC cut-off was ≥ 150 µg/g. To differentiate pCD from cryptoglandular fistulas in the absence of luminal inflammation, optimal cut-off remained ≥ 150 µg/g (AUC = 0.857, sensitivity = 0.81, specificity = 0.89, positive predictive value (PPV) = 93.8% and negative predictive value (NPV) = 70.8%). In pCD, FC was significantly increased in the presence of ulcers (1672.0 vs 238.0, p = 0.004). Optimal cut-off was ≥ 250 µg/g (AUC = 0.776; sensitivity = 0.89, specificity = 0.56, PPV - 68.0% and NPV = 83.0%). Conclusion FC discriminates pCD from cryptoglandular fistulas, even in the absence of intestinal ulcers. In active pCD, an elevated FC does not accurately predict the presence of ulcers and should be interpreted with caution.

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“…Perianal fistula formation following drainage of anorectal abscesses is common and associated with significant morbidity. They result from the formation of an epithelized tract between the anal canal and perianal skin, most commonly following infection originating from an anal gland [1]. Perianal fistulas reportedly develop in approximately 37% of patients who undergo incision and drainage (I&D) of anorectal abscesses [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Influence of adjuvant antibiotics on fistula formation following incision and drainage of anorectal abscesses: a systematic review protocol

et al. 2019

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Background Development of fistula-in-ano following incision and drainage (I&D) of anorectal abscesses occurs in over 30% of patients. It is associated with significant patient morbidity and societal cost. The use of antibiotics following drainage is controversial, with randomized controlled trials reporting opposing conclusions regarding their influence on the rate of fistula formation. Given the significant burden associated with their development, it is imperative to determine strategies to minimize their occurrence. The objective of this review is to summarize the available evidence on the role of antibiotics following I&D of anorectal abscesses on fistula formation. Secondary objectives include determining if antibiotics are associated with morbidity, repeat presentation to the emergency department, and requirement for reoperation. Methods/design MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials, http://apps.who.int/trialsearch , and clinicaltrials.gov will be searched to identify published and ongoing unpublished interventional and observational studies evaluating the role of antibiotics post I&D on the incidence of fistula formation. There will be no restriction on language, date, or journal. Title and abstracts as well as full texts will be screened in duplicate based on inclusion and exclusion criteria. The Cochrane Risk of Bias tool and ROBINS-I will be used to assess risk of bias in randomized and non-randomized studies, respectively. Our primary outcome is the incidence of fistula formation; secondary outcomes include morbidity, representation to ED, and reoperation. Study heterogeneity will be calculated with Cochran’s Q test, P value, and I 2 index. SASS (version 9.4) will be used for meta-analysis. Discussion This is the first study to review the available evidence on adjuvant antibiotics and incidence of fistula formation following I&D of anorectal abscesses. Systematic review registration PROSPERO CRD42018092044 Electronic supplementary material The online version of this article (10.1186/s13643-019-1002-z) contains supplementary material, which is available to authorized users.

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The cryptoglandular theory revisited

Cited by 38 publications

References 15 publications

Prevalence of anal fistula in the United Kingdom

Prevalence of anal fistula in the United Kingdom

Diagnostic accuracy of faecal calprotectin in patients with active perianal fistulas

Influence of adjuvant antibiotics on fistula formation following incision and drainage of anorectal abscesses: a systematic review protocol

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