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P347. Epidemiological study of perianal fistulas in patients with Crohn's disease

M. Chaparro1, P. Burgueño1, I. Vera2, F. Bermejo3, I. Marín-Jimenez4, C. Yela5, P. López6, M. Martín7, C. Taxonera8, B. Botella9, R. Pajares10, A. Ponferrada11, M. Calvo2, A. Algaba3, L. Pérez4, B. Casis5, J. Maté1, J.P. Gisbert1

1Hospital de la Princesa, Madrid, Spain; 2Hospital Puerta de Hierro, Madrid, Spain; 3Hospital de Fuenlabrada, Madrid, Spain; 4Hospital Gregorio Marañón, Madrid, Spain; 5Hospital Doce de Octubre, Madrid, Spain; 6Hospital de Alcorcón, Madrid, Spain; 7Hospital de la Paz, Madrid, Spain; 8Hospital Clínico San Carlos, Madrid, Spain; 9Hospital Infanta Cristina, Madrid, Spain; 10Hospital Infanta Sofía, Madrid, Spain; 11Hospital Infanta Leonor, Madrid, Spain

Introduction: Perianal complications in patients with Crohn's disease (CD) are particularly relevant due to its impact on the quality of life of these patients. Very few studies have been carried out on the epidemiology of perianal fistula in CD patients.

Aim: To understand the epidemiology of perianal fistula in CD patients.

Methods: A transversal multicentre study was carried out in 11 hospitals in Madrid. A perianal fistula was classified as complex if it fulfilled any of the following criteria: high location (high intersphincteric, high transsphincteric, extrasphincteric or suprasphincteric), multiple external openings, perianal abscess, anal stenosis or proctitis. All other fistulas were classified as simple.

Results: 2,391 patients of whom 581 (24%) had developed perianal fistula at some point since diagnosis of CD were included. The mean time of evolution of CD was 12 years. The cumulative incidence of perianal fistula was 24% (95% CI: 22–30%) and the cumulative incidence of complex perianal fistula was 12% (95% CI: 11–13%). The rate of incidence of development of perianal fistula was 1.2% per patient-year during the study time period, and for complex fistula it was 0.7% per patient-year. The median age of patients with perianal fistula was 41 years, and 55% were male. 83% of patients had colonic location (53% ileocolonic) and 62% inflammatory behaviour.

51% of simple fistulas were superficial, 27% low transsphincteric and 22% low intersphincteric. The most common location of the complex fistulas was high inter- or transsphincteric (43%), followed by low inter- or transsphincteric (31%), suprasphincteric (11%), extrasphincteric (9%) and superficial (10%). 74% of complex fistulas were associated with perianal abscess, 35% with proctitis, 10% with anal stenosis and 35% had various external openings.

Conclusions: Perianal fistulas are very common, appearing in 25% of CD patients. Of these, approximately half are complex. Complex perianal fistulas are frequently associated with the presence of perianal abscess and in a significant percentage of patients with anal stenosis.