T. Wallenhorst1, L. Siproudhis1, G. Bouguen1, I. Berkelmans1, P.‑N. d'Halluin1, J.‑F. Bretagne1
1CHU Pontchaillou, Gastroenterology Unit, Rennes, France
Background: Intestinal phenotype of Crohn's disease (Montreal classification) is currently used to diagnose and to treat patients with luminal Crohn's disease. Anal lesions frequently occur in association but they are poorly described in Montreal classification (p). The aim of the study was to better assess both anal and luminal Crohn's disease.
Methods: Clinical features of consecutive patients constitute a single-centered prospective database of anal lesions of CD (01/01/2007 to 08/30/2011). The data for luminal disease, perineal disease and therapy were prospectively collected using validated scales (Montreal classification, HarveyBradshaw index, UFS classification, Perineal Disease Activity Index). Phenotypes and symptomatic scores of both luminal and perianal disease have been analyzed in combination.
Results: 282 patients (M/F: 108/174; mean age 38.7±16.3 years) were referred for Crohn's disease: 67 with anal ulcerations, 31 with anal fistulas, 87 with both conditions and 97 with no anal lesions. Biotherapy has been instituted in 183 patients. Montreal phenotypes of luminal disease at referral was not different between groups. Results are summarized in the table.
|Anal lesions||Ulcerations (N = 67)||Ulcerations & fistulas (N = 87)||Fistulas (N = 31)||No lesion (N = 97)||p|
|Mean age (y) (m±sd)||35±17||34.3±16||39.3±12||40.1±2||<0.05|
|Disease duration (m) (m±sd)||97±99||90±98||145±120||115±90||<0.05|
|Body Mass Index (m±sd)||21.6±3.8||21.6±4.3||24.3±4.3||25.1±6.3||0.001|
|Intestinal resection (%)||10 (14.9)||19 (21.8)||15 (48.4)||31 (40)||0.002|
|No biotherapy (%)||13 (19.4)||23 (26.4)||11 (35.5)||52 (53.6)||0.0001|
|Anal stenosis (%)||12 (17.9)||28 (32.1)||6 (19.4)||3 (3.1)||0.001|
Conclusions: There is no link between luminal and anal phenotypes as regard to the types of intestinal lesions and sites. However, patients with anal ulcerations suffered from a more severe disease activity on both luminal (IMC, HB) and anal locations (PDAI, stenosis). This may be taken into account to plan therapeutic strategies such as biotherapies.