Clinical features and therapeutic requirements of perianal disease in adult patients with ulcerative colitis: the PERICO study of the ENEIDA registry

Background Perianal disease (PD) may occur in ulcerative colitis (UC), but scarce data on its features, clinical course, and common therapeutic approach are available. Our aim was to describe the prevalence, clinical characteristics and therapeutic requirements of PD among patients with UC. Methods Patients with UC and PD were identified from the ENEIDA registry of GETECCU. Epidemiological, clinical, and therapeutic data were retrospectively gathered and reviewed from medical records. Results From a total cohort of 9884 patients with UC, 411 developed PD, leading to an incidence rate of 0.5 cases per 100 person-years. Ninety-one patients (22%) developed PD before being diagnosed with UC. The most common perianal lesions at clinical presentation were fissures (52%), followed by fistulae (44%), and abscesses (39%). In the logistic regression analysis, male gender (OR 1.32 [95% CI, 1.10-1.58]; P = .002) and extra-intestinal manifestations (OR 1.88 [95% CI, 1.39-2.52]; P < .0001) were risk factors for PD, whereas ulcerative proctitis (OR 0.66 [95% CI, 0.51-0.86]; P = .002) was the only protective factor. Surgical techniques were used in 44% of patients with PD, and biologicals were indicated due to PD in 12%. Overall, the rate of PD remission was 91%. Conclusions Approximately 4% of patients with UC develop PD, occurring before the diagnosis of UC in one fourth. PD seems to behave less aggressively than in Crohn’s disease, being easily managed conservatively or with perianal surgery and needing biological agents only in a minority of patients.