Prevalence, clinical characterisation and therapeutic outcomes of non-fistulising perianal lesions in Crohn’s disease (ULCERS-CD): Results from the ENEIDA registry of GETECCU

Abstract

Background Non-fistulising perianal lesions (NFPL) in Crohn’s disease—including skin tags, fissures, ulcers, and anorectal strictures—are poorly described. Moreover, evidence on treatment response is scarce and heterogeneous, limiting therapeutic decision-making. We aimed to characterise NFPL in a real-world nationwide cohort and to evaluate therapeutic strategies and clinical outcomes.

Methods Adult CD patients with NFPL (fissures, ulcers, strictures) recorded in the prospectively maintained ENEIDA registry of GETECCU, were included. Demographics, and clinical characteristics were collected. Clinical records were additionally reviewed to obtain detailed information on NFPL features and treatments received. The frequency of NFPL within the registry population was calculated. For treatment evaluation (fissures), only patients with ≥12-week follow-up after NFPL diagnosis were analysed. Clinical response was defined as complete healing of the lesion according to physician assessment. Treatment strategies for NFPL were evaluated across therapeutic lines (first, second and third). Global therapeutic response was defined as complete healing at any therapeutic line of the same treatment.

Results Among 36,661 patients with Crohn’s disease included in ENEIDA, 8,667 had perianal disease. Of these, 2,434 patients (28%, 95% CI = 28-29%) had NFPL. We included 490 patients (mean age at NFPL diagnosis: 34 years; male: 51%; Montreal location L1/L2/L3: 36%/24%/40%; behaviour B1/B2/B3: 70%/13%/17%; concomitant fistulising perianal disease: 33%). Anal fissure was the most frequent lesion (417/490; 85%), followed by anorectal strictures (53/490; 11%) and cavitating ulcers (52/490; 11%). Clinical characteristics of these patients are detailed in table 1. For treatment analysis, 417 patients with fissures and complete follow-up were evaluated (female: 51%; location L1/L2/L3: 39%/22%/39%; behaviour B1/B2/B3: 72%/16%/16%; concomitant fistulising perianal disease: 31%). First-line therapy induced clinical healing in 66% (224/341; 95% CI 60–71%): vasodilators 63%, botulinum toxin 60%, surgery 95%, biologics 54%. Global therapeutic response was: vasodilators 80%, surgery 78%, botulinum toxin 76%, biologics 77%. Overall, 70% (291/417) of patients achieved clinical healing of the fissure.

Conclusion Non-fistulising perianal lesions are common in Crohn’s disease and respond favourably to standard therapies. In a real-world nationwide cohort, anal fissures predominated, and two-thirds of patients responded to first-line therapy, with overall 70% of patients achieving complete healing, supporting that these lesions should be recognised, diagnosed early, and treated following structured therapeutic pathways.