TOPLINE:

Children who presented with perianal abscess or fistula-in-ano faced an age-dependent increased risk of developing Crohn's disease (CD); over 1 in 5 children were diagnosed with CD. The recurrence of perianal disease and the presence of gastrointestinal (GI) symptoms were associated with increased odds of CD diagnosis.

METHODOLOGY:

• Researchers conducted a retrospective study across five hospitals in Netherlands to assess the proportion of children with perianal abscess or fistula-in-ano who go on to develop CD and to map the time interval from presentation to diagnosis across age groups (January 2000 to December 2018).
• They analysed data of 152 children with perianal abscess or fistula-in-ano (median age, 11.1 years; 78.3% boys) who were followed up over a median duration of 6.2 years.
• Children were stratified into three subgroups on the basis of age: 2 to < 6 years (n = 28), 6 to < 12 years (n = 53), and 12 to < 18 years (n = 71).

TAKEAWAY:

• Overall, 21.1% of children were diagnosed with CD, with a median duration of 4.7 months between the presentation of perianal abscess or fistula-in-ano and the diagnosis of CD.
• Children aged 12-18 years had a higher likelihood of developing CD than those aged 2-6 years (32.4% vs 3.6%; odds ratio [OR], 14.24; P = .01) and 6-12 years (32.4% vs 15.1%; OR, 2.09; P = .03).
• Children with vs without the recurrence of perianal disease had a higher risk of developing CD (OR, 3.20; P = .005). Inflammatory bowel disease‑related GI symptoms at the presentation of perianal abscess or fistula-in-ano were also linked to an increased risk of developing CD (OR, 4.85; P < .001).
• Among 20 children in whom faecal calprotectin levels were measured, median faecal calprotectin levels were higher in those with CD (n = 10; 1212 μg/g) than in those without CD (n = 10; 22.5 μg/g; P < .001).

IN PRACTICE:

"Our findings emphasize the need for high awareness by physicians in children presenting with PA/FIA [perianal abscess/fistula-in-ano] for development of CD, also in the years following first presentation, particularly when aged ≥ 6 years," the authors of the study wrote.

SOURCE:

This study was led by Mariëlle Roskam, Emma Children's Hospital, Amsterdam Medical Center, Amsterdam, Netherlands. It was published online on February 25, 2026, in the Journal of Pediatric Gastroenterology and Nutrition.

LIMITATIONS:

This study was limited by its retrospective design, the sample size that was not suitable for all statistical analyses, and the underrepresentation of children managed outside surgical services.

DISCLOSURES:

This study did not receive any funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.