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P50 Unique phenotypical characteristics and treatment patterns affecting outcomes in South Asian patients with perianal fistula in UK
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P50 Unique phenotypical characteristics and treatment patterns affecting outcomes in South Asian patients with perianal fistula in UK
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Journal Article
P50 Unique phenotypical characteristics and treatment patterns affecting outcomes in South Asian patients with perianal fistula in UK
2025
Overview
BackgroundSouth Asians (SA) patients with IBD have been identified to have more complex phenotype of CD including perianal fistula CD-PAF. We aimed to determine whether CD-PAF characteristics and outcomes were different in SA IBD vs Caucasians.MethodsThis was a retrospective case controlled retrospectively study of fistula patients matching of 1 SA patient with fistula to 2 Caucasian fistula patients in the centres participating in the study. Baseline fistula characteristics and treatment patterns were collected. Fistula outcomes at 12 months from diagnosis of fistula was recorded.Results75 SA and 150 Caucasian patients were included. SA patients with fistula were diagnosed at younger age than Caucasians (median age 24 Vs 31). CD-PAF was present at diagnosis in higher proportion of SA patients (21/75 vs 30/150). Colonic involvement and presence of proctitis was higher in SA fistula patients (55/75 vs 81/150). SA patients had higher proportion of complex perianal fistula (51/75 vs 93/150) compared to Caucasians. There was no difference in the proportion of patients needing abscess drainage, number of examinations under anaesthesia and seton insertion. South Asian patients were treated more often with steroids (63/75 vs 103/150) and less often with biologics (26/75 vs 97/150) within 1 year of diagnosis of fistula. In addition, time to initiation of first biologics was longer in SA patients (median 9 months vs 4 months). There was no difference in the proportion of patients on immunosuppressants. Nine patients of SA descent were on complementary and alternative therapies (CAMs) while none of the Caucasian patients were on CAMs. Lower number of south Asian patients had diverting stoma (11/75 vs 38/150) and proctectomy 6/75 vs 18/150). Long term seton drainage was instituted in higher proportion of SA patients compared to SA (28/75 Vs 44/150). Complete fistula healing was lower in the SA patients 16/75 vs 41/150).ConclusionWe found unique phenotypic CD-PAF characteristics among South Asian patients, along with altered medication use and surgery patterns. The fistula outcomes appear to be worser in SA patients with CD-PAF.
Publisher
BMJ Publishing Group LTD
Subject
