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Gastroenterology Clinics of North... Mar 2022Painful and bothersome anorectal syndromes can be a diagnostic and therapeutic challenge for clinicians because structural and functional abnormalities may often coexist... (Review)
Review
Painful and bothersome anorectal syndromes can be a diagnostic and therapeutic challenge for clinicians because structural and functional abnormalities may often coexist and require a multidisciplinary approach to management. Although it is often difficult to attribute all of a patient's anorectal symptoms to a singular disorder with definitive intervention and cure, improving quality of life, treating coexistent conditions such as functional constipation and/or defecation disorders, addressing psychological comorbidities if present, and confirming there is no evidence of inflammatory or malignant conditions are top priorities.
Topics: Anal Canal; Anus Diseases; Constipation; Fistula; Hemorrhoids; Humans; Pain; Quality of Life; Syndrome
PubMed: 35135658
DOI: 10.1016/j.gtc.2021.10.008 -
Journal of Pediatric Gastroenterology... Jan 2018Perianal disease (PD) with fistula and/or abscess formation is a severe complication in Crohn disease (CD). We examined prevalence, incidence, and risk factors for PD...
OBJECTIVES
Perianal disease (PD) with fistula and/or abscess formation is a severe complication in Crohn disease (CD). We examined prevalence, incidence, and risk factors for PD development in a pediatric CD cohort.
METHODS
Patients with CD from the prospective, multicenter registry for inflammatory bowel disease from Germany and Austria (CEDATA-GPGE) were included if diagnosed at the age of 18 years or younger, registered within 3 months after diagnosis, and having at least 2 follow-up visits within the first year of registration. We examined potential risk factors for PD with Kaplan-Meier analysis and a final Cox model considering sex, family history of inflammatory bowel disease, extraintestinal manifestations, disease location, and induction therapy (corticosteroids or nutritional therapy).
RESULTS
Of 2406 patients with CD, 742 fulfilled inclusion criteria (59% boys, mean age at diagnosis 12.4 ± 3.4 years). PD was present at diagnosis in 41 patients (5.5%; 80.9% boys), whereas 32 patients (4.3%, 81.3% male) developed PD during follow-up (mean 2.0 ± 1.6 years). The cumulative incidence of PD at 12 and 36 months after diagnosis was 3.5% and 7.5%, respectively. Potential risk factors for PD development during follow-up were male sex (hazard ratio = 3.2, [95%; confidence interval 1.2-7.8]) and induction therapy with corticosteroids (hazard ratio = 2.5 [1.1-5.5]). Diagnostic evaluation at PD diagnosis was incomplete in 40% of affected subjects. PD resolved within 1 year in 50% of cases.
CONCLUSIONS
Approximately 10% of CD patients in our cohort suffered from PD within the first 3 years of their disease. Male sex and initial corticosteroid therapy were associated with an increased risk to develop PD after diagnosis.
Topics: Adolescent; Anus Diseases; Austria; Child; Child, Preschool; Crohn Disease; Female; Follow-Up Studies; Germany; Humans; Incidence; Infant; Male; Prevalence; Registries; Retrospective Studies; Risk Factors
PubMed: 28604511
DOI: 10.1097/MPG.0000000000001649 -
Journal of Cutaneous Medicine and... 2017Perineal streptococcal dermatitis (PSD) is largely known to be caused by group A β-hemolytic Streptococcus (GAS). We would like to bring cases of non-GAS PSD to the... (Review)
Review
Perineal streptococcal dermatitis (PSD) is largely known to be caused by group A β-hemolytic Streptococcus (GAS). We would like to bring cases of non-GAS PSD to the attention of dermatologists, as there are implications for workup and therapy. We report 3 pediatric cases of PSD: 1 caused by GAS, 1 caused by group B β-hemolytic Streptococcus (GBS), and 1 associated with group C β-hemolytic Streptococcus (GCS). GBS and GCS are very rarely reported in pediatric cases of PSD. The literature on non-GAS PSD is reviewed, which additionally revealed several instances of PSD caused by group G β-hemolytic Streptococcus (GGS) and Staphylococcus aureus. GBS, GCS, GGS, and S aureus are significant causes of PSD to consider, particularly among adult patients, based on our encountered cases and the literature. If using rapid antigen tests to expedite the diagnosis of GAS, we recommend supplementing with a lesional swab for bacterial culture and sensitivity as the rapid antigen test does not detect non-GAS organisms. Therapy should be tailored to the microbiologic cause.
Topics: Anus Diseases; Child, Preschool; Female; Humans; Male; Perineum; Skin Diseases, Bacterial; Streptococcal Infections; Streptococcus agalactiae; Streptococcus pyogenes; Vulvar Diseases
PubMed: 27628908
DOI: 10.1177/1203475416670369 -
The British Journal of Surgery Dec 2017Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following an abscess. The aim was to assess the...
BACKGROUND
Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following an abscess. The aim was to assess the burden of anorectal abscess and to identify risk factors for subsequent fistula formation.
METHODS
The Hospital Episode Statistics database was used to identify all patients presenting with new anorectal abscesses. Cox regression analysis was undertaken to identify factors predictive of fistula formation.
RESULTS
A total of 165 536 patients were identified in the database as having attended a hospital in England with an abscess for the first time between 1997 and 2012. Of these, 158 713 (95·9 per cent) had complete data for all variables and were included in this study, the remaining 6823 (4·1 per cent) with incomplete data were excluded from the study. The overall incidence rate of abscess was 20·2 per 100 000. The rate of subsequent fistula formation following an abscess was 15·5 per cent (23 012 of 148 286) in idiopathic cases and 41·6 per cent (4337 of 10 427 in patients with inflammatory bowel disease (IBD) (26·7 per cent coded concurrently as ulcerative colitis; 47·2 per cent coded as Crohn's disease). Of all patients who developed a fistula, 67·5 per cent did so within the first year. Independent predictors of fistula formation were: IBD, in particular Crohn's disease (hazard ratio (HR) 3·51; P < 0·001), ulcerative colitis (HR 1·82; P < 0·001), female sex (HR 1·18; P < 0·001), age at time of first abscess 41-60 years (HR 1·85 versus less than 20 years; P < 0·001), and intersphincteric (HR 1·53; P < 0·001) or ischiorectal (HR 1·48; P < 0·001) abscess location compared with perianal. Some 2·9 per cent of all patients presenting with a new abscess were subsequently diagnosed with Crohn's disease; the median time to diagnosis was 14 months.
CONCLUSION
The burden of anorectal sepsis is high, with subsequent fistula formation nearly three times more common in Crohn's disease than idiopathic disease, and female sex is an independent predictor of fistula formation following abscess drainage. Most fistulas form within the first year of presentation with an abscess.
Topics: Abscess; Adult; Age Factors; Anus Diseases; Datasets as Topic; England; Female; Humans; Incidence; Inflammatory Bowel Diseases; Male; Middle Aged; Rectal Fistula; Risk Factors; Sex Factors; Young Adult
PubMed: 28857130
DOI: 10.1002/bjs.10614 -
Journal of Pediatric Surgery Jun 2024Pediatric patients with perianal Crohn's Disease (CD) suffer recalcitrant fistulas, abscesses, and strictures. Fecal diversion is a palliative last resort, but the...
INTRODUCTION
Pediatric patients with perianal Crohn's Disease (CD) suffer recalcitrant fistulas, abscesses, and strictures. Fecal diversion is a palliative last resort, but the expected clinical course and long-term management of the ostomy for this population is unclear. We sought to identify factors predictive of ostomy takedown and establish management recommendations for fistulizing and stenosing disease.
METHODS
We reviewed our institutional registry for patients aged 1-18 years with CD who received perianal surgery from 2011 to 2021. We analyzed medical therapy, examinations under anesthesia (EUA), fistula and stenosis response, and rates of fecal diversion and reversal.
RESULTS
There were 109 patients with fistulizing CD and 21 with stenosing CD. There were 8 diverted for fistula and 4 due to stricture [8/109 (7 %) vs 4/21 (19 %), p = 0.213]. Three patients with fistulizing disease had their ostomy reversed at an average of 1.46 years. Each demonstrated consistent CD control and with no additional perianal flares. The remainder have been diverted 3.15 ± 4.57 years with 2.1 ± 2.8 EUAs. Only one patient with stricture was durably reversed, but they still require serial anal dilation. Two were reversed but required re-diversion due to stricture progression.
CONCLUSION
Reversal rates after fecal diversion for pediatric perianal CD remain disappointingly low and diversion does not obviate the possibility of future EUAs. While reversal was successful for medically responsive patients with fistulizing disease, those with stenosing disease remained dependent on anal dilations and were more likely to fail reversal. Fecal diversion does nothing to reverse an established stricture and such patients will likely need to decide between indefinite dilations or permanent ostomy.
LEVEL OF EVIDENCE
IV.
TYPE OF STUDY
Retrospective review.
Topics: Humans; Crohn Disease; Child; Adolescent; Male; Female; Child, Preschool; Retrospective Studies; Infant; Ostomy; Constriction, Pathologic; Rectal Fistula; Anus Diseases
PubMed: 38104035
DOI: 10.1016/j.jpedsurg.2023.11.009 -
Der Hautarzt; Zeitschrift Fur... Jun 2015Sexually transmitted infections (STIs) are increasingly observed in men who have sex with men (MSM), which is associated with the success in the antiretroviral treatment... (Review)
Review
BACKGROUND
Sexually transmitted infections (STIs) are increasingly observed in men who have sex with men (MSM), which is associated with the success in the antiretroviral treatment of HIV infection. Additionally, in heterosexuals, anal intercourse is more prevalent than previously assumed. Thus, anorectal manifestations of STIs are not a rare condition.
OBJECTIVES
This review will focus on the clinical picture, diagnosis and therapy of frequent STIs involving the anorectal region.
CONCLUSIONS
Due to localisation and frequent asymptomatic course, STIs in this region often pose diagnostic problems. Anorectal manifestations of STIs consist of tumorous masses, ulcers or proctitis and may be misdiagnosed as malignancy or inflammatory bowel disease. Herpes simplex and syphilis primarily show ulcerations and may involve the perianal region, whereas gonorrhoea and lymphogranuloma venereum mainly cause proctitic symptoms with exsudation. Because of commonly occurring coinfections a complete diagnostic workup concerning other STIs should be performed.
Topics: Anus Diseases; Coinfection; Diagnosis, Differential; Female; Homosexuality, Male; Humans; Male; Rectal Diseases; Sexual Behavior; Sexually Transmitted Diseases
PubMed: 25898890
DOI: 10.1007/s00105-015-3627-8 -
Alimentary Pharmacology & Therapeutics May 2023
Topics: Humans; Crohn Disease; Anus Diseases; Rectal Fistula; Wound Healing
PubMed: 37053478
DOI: 10.1111/apt.17377 -
Canadian Journal of Rural Medicine :... 2021
Topics: Abscess; Anus Diseases; Clinical Competence; Drainage; Humans; Practice Patterns, Physicians'; Rural Health Services; Rural Population
PubMed: 33380604
DOI: 10.4103/CJRM.CJRM_16_20 -
Digestive Diseases (Basel, Switzerland) 2021Perianal disease is associated with a disabling course of Crohn's disease (CD). We aim to study the impact of perianal disease on CD remission rates, after a 1-year...
BACKGROUND
Perianal disease is associated with a disabling course of Crohn's disease (CD). We aim to study the impact of perianal disease on CD remission rates, after a 1-year course of infliximab in combination therapy with azathioprine.
METHODS
This was a retrospective, single-center cohort study, including consecutive CD patients on combination therapy, followed for 1 year since induction. The outcome variable was split into clinical and endoscopic remissions. The correlation toward the outcome variable was assessed with univariate and multivariate analysis and a survival assessment, using SPSS software.
RESULTS
We assessed 74 CD patients, of whom 41 (55.4%) were female, with a mean age of 36 years. Thirty-nine percent of the patients presented perianal disease at diagnosis (n = 29). We documented 70.3% clinical and 47.2% endoscopic remissions. Several variables had statistical significance toward the outcomes (endoscopic and clinical remissions) in the univariate analysis. After adjusting for confoundment, patients with perianal disease presented an odds ratio (OR) of 0.201 for achieving endoscopic remission (CI: 0.054-0.75, p value 0.017) and an OR of 0.203 for achieving clinical remission (CI: 0.048-0.862, p value 0.031). Sixty-six patients (89.2%) presented an initial response to treatment, from whom, 20 (30.3%) exhibited at least 1 disease relapse (clinical and/or endoscopic). Patients with perianal disease presented higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meier curves (Breslow p value 0.043).
CONCLUSION
In the first year of combination therapy, perianal disease is associated with an 80% decrease in endoscopic and clinical remission rates and higher ratio of disease relapse.
Topics: Adult; Anal Canal; Anus Diseases; Azathioprine; Crohn Disease; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Female; Gastrointestinal Agents; Humans; Induction Chemotherapy; Infliximab; Kaplan-Meier Estimate; Male; Odds Ratio; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 33197911
DOI: 10.1159/000513067 -
Pediatric Surgery International Oct 2023
Topics: Humans; Abscess; Anus Diseases; Rectal Fistula
PubMed: 37801089
DOI: 10.1007/s00383-023-05563-2