The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Self-screening questionnaire for perianal fistulizing disease in patients with Crohn's disease

  • O Seong Kweon (Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine) ;
  • Ben Kang (Department of Pediatrics, Kyungpook National University, School of Medicine) ;
  • Yoo Jin Lee (Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine) ;
  • Eun Soo Kim (Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine) ;
  • Sung Kook Kim (Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine) ;
  • Hyun Seok Lee (Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine) ;
  • Yun Jin Chung (Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine) ;
  • Kyeong Ok Kim (Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine) ;
  • Byung Ik Jang (Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine)
  • Received : 2023.09.27
  • Accepted : 2023.12.19
  • Published : 2024.05.01
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Abstract

Background/Aims: A poor prognostic factor for Crohn's disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess perianal symptoms in patients with CD remains nonexistent. This study aimed to develop a perianal fistulizing disease self-screening questionnaire for patients with CD. Methods: This prospective pilot study was conducted at three tertiary referral centers between January 2019 and May 2020. We formulated questions on perianal symptoms, including tenesmus, anal discharge, bleeding, pain, and heat. A 4-point Likert scale was used to rate each question. Patients with CD completed a questionnaire and underwent pelvic magnetic resonance imaging (MRI). Results: Overall, 93 patients were enrolled, with 51 (54.8%) diagnosed with perianal fistulizing disease, as determined by pelvic MRI. The Spearman correlation findings demonstrated that anal pain (p = 0.450, p < 0.001) and anal discharge (p = 0.556, p < 0.001) were the symptoms that most significantly correlated with perianal disease. For anal pain and discharge, the area under the receiver operating characteristic curve of the scores was significantly higher than that of the combined score for all five symptoms (0.855 vs. 0.794, DeLong's test p = 0.04). For the two symptoms combined, the sensitivity, specificity, and positive predictive and negative predictive values were 88.2, 73.8, 80.4, and 83.8%, respectively, with 81.7% accuracy for detecting perianal fistulizing disease. Conclusions: This study indicates that simple questions regarding anal pain and discharge can help accurately identify the presence of perianal fistulizing disease in patients with CD.

Keywords

Acknowledgement

This work was supported by a Biomedical Research Institute grant of Kyungpook National University Hospital (2021).

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