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Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement

de Zoeten, Edwin F.*; Pasternak, Brad A.; Mattei, Peter§; Kramer, Robert E.*; Kader, Howard A.

Journal of Pediatric Gastroenterology and Nutrition: September 2013 - Volume 57 - Issue 3 - p 401–412
doi: 10.1097/MPG.0b013e3182a025ee
Clinical Reports

ABSTRACT Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract that includes both Crohn disease (CD) and ulcerative colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss characterize both CD and ulcerative colitis. The incidence of IBD in the United States is 70 to 150 cases per 100,000 individuals and, as with other autoimmune diseases, is on the rise. CD can affect any part of the gastrointestinal tract from the mouth to the anus and frequently will include perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal disease has become a recognized entity and an important consideration in the diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as inflammation at or near the anus, including tags, fissures, fistulae, abscesses, or stenosis. The symptoms of PCD include pain, itching, bleeding, purulent discharge, and incontinence of stool. In this report, we review and discuss the etiology, diagnosis, evaluation, and treatment of PCD.

*Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Digestive Health Institute, Pediatric Inflammatory Bowel Disease Center, Denver, CO

Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Maryland School of Medicine Pediatric Inflammatory Bowel Disease Center, Baltimore, MD

Department of Pediatric Gastroenterology, Phoenix Children's Hospital, Phoenix, AZ

§Department of Surgery, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA.

Address correspondence and reprint requests to Edwin de Zoeten, MD, PhD, Pediatric IBD Center, Children's Hospital Denver Digestive Health Institute, Anschutz Medical Campus, 13123 East 16th Ave, B290 Aurora, CO 80045.

Received 18 June, 2013

Accepted 6 June, 2013

This article has been developed as a Journal CME Activity by NASPGHAN. Visit http:// /wmspage.cfm?parm1=742 to view instructions, documentation, and the complete necessary steps to receive CME credit for reading this article.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,