Epidemiology, treatment patterns, and associated risk factors in perianal fistulizing Crohn's disease: A systematic literature review.

BACKGROUND

Data regarding complex Crohn's perianal fistulas (CPF) epidemiology are limited, and optimal treatment strategies are elusive. An improved understanding of how CPF treatment options are used in the real-world setting and factors associated with CPF development, treatment failure, and reasons for undergoing multiple surgeries may help to inform optimal patient management strategies, reduce treatment burden, and improve outcomes in patients with CPF.

AIM: To describe the epidemiology, treatments, outcomes, and associated risk/protective factors for complex CPF.

METHODS

Electronic databases (MEDLINE, EMBASE, EBM Reviews, EconLit) were searched. Two reviewers independently used populations, interventions, comparators, outcomes, study designs, and time criteria to identify relevant studies. Observational studies published in English from January 1, 2015 to February 17, 2022 with > 50 patients were included, even if complex CPF was not defined. Items of interest included complex CPF definitions, epidemiology, treatment patterns, morbidity, mortality, and risk factors associated with complex CPF development, treatment failure, and undergoing multiple surgeries. Data were reported using descriptive statistics.

RESULTS

Overall, 140 studies were included. Complex CPF definitions were heterogeneous and rarely reported (24 studies). Hence, data mostly related to CPF in general. CPF prevalence was variable (range: 1.5%-81.0%). Incidence was wide-ranging and mostly reported cumulatively at 1-year post-Crohn's disease diagnosis (range: 3.5%-50.1%). Overall healing and failure rates after treatment were in the range of 10.5%-80.2% and 3.6%-83.0%, respectively. Abscesses were the most frequently reported morbidity (n = 18). No CPF-related deaths were reported. No consistent risk or protective factors were identified.

CONCLUSION

Epidemiology, treatment patterns, and risk factors for CPF vary, likely due to inconsistent CPF and clinical outcome definitions. Standardization would facilitate comparability, which may inform optimal complex CPF treatment strategies.