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P131. Anal ulceration in Crohn's disease: Natural history at the time of biotherapy


T. Wallenhorst1, L. Siproudhis1, G. Bouguen1, I. Berkelmans1, P.‑N. d'Halluin1, J.‑F. Bretagne1

1CHU Pontchaillou, Gastroenterology Unit, Rennes, France



Background: Anal ulcerations represent one of the characteristics of Crohn's disease (CD), but their natural history is poorly understood. Using the largest published series of anal ulcerations, the aim of this study was to clarify their outcomes at the time of biotherapy.

Methods: Clinical features of 282 consecutive patients constituted a single-centered prospective database of anal lesions of CD (from 01/01/2007 to 08/30/2011). The data for luminal disease (Montreal classification, Harvey–Bradshaw index), perianal disease (UFS classification, PDAI) and ongoing treatments were prospectively collected at referral and at follow-up. The description of ulcerations and their healing rates were analyzed.

Results: A total of 154 patients (male = 55, female = 99; mean age 36±16 years) had at least, one anal ulceration: it was one or more severe ulcerations (U2) in 77 cases. Mean follow-up was 84±86 weeks but 15 were examined once. The treatment for CD was infliximab, adalimumab, and azathioprine in 109 (71%), 44 (29%) and 111 (77%) patients respectively. The mean time to healing of ulcerations was 56±74 weeks: 45 (32%) patients did not heal permanently at the end of follow-up. The ulcerations were associated with suppuration (with surgical drainage) or anal stenosis in 87 (57%) and 40 (26%) patients respectively. New surgical drainage was performed in 37 (43%) patients but only 4 of 36 patients (11%) with initially non-fistulizing disease had suppurative complication de novo. Patients in whom anal ulcerations persisted, had, at follow-up, a higher Harvey–Bradshaw score (4±21 vs. 2±13) and a higher PDAI (6±20 vs. 1±10), but they had less surgical drainage and surgical reconstruction. Multivariate analysis showed, that the nature of the ulceration (U2) (but not therapeutic interventions: biotherapy, surgery) was associated with a lower chance of healing (OR 0.275, 95% CI: 0.09 to 0.85, p < 0.05).

Conclusions: Anal ulcerations of CD are associated with suppuration in more than half cases. A third has not healed after 18 months of follow-up (including U2). These findings call for trials specifically focused on the treatment of anal ulcerations.