Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1795
Peer-review started: February 26, 2019
First decision: March 28, 2019
Revised: May 8, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: July 26, 2019
Processing time: 153 Days and 20.5 Hours
Anal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated.
To assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe.
A retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported.
The United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44; 95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare.
This real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.
Core tip: There is no recent data on the prevalence of anal fistula in Europe. The frequency of underlying risk conditions in anal fistula is also poorly understood. This real-world evidence study aimed to estimate United Kingdom and Europe-standardized prevalence of anal fistula, with and without Crohn’s disease (CD), and describe the prevalence of relevant comorbidities among patients with anal fistula. Data was derived from the The Health Improvement Network database. Overall, the United Kingdom and Europe- standardized prevalence of anal fistula were 1.80 and 1.83 per 10000 patients respectively in 2017 (1.89-2.36 in 2014-2016). Approximately 25% of anal fistula cases may be associated with CD, while other comorbidities are rare.