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P655. Diffuse jejunoileitis – a unique subtype of Crohn's disease?

M. Majerovic1, M. Brinar1, M. Crncevic Urek1, S. Cukovic-Cavka1, B. Vucelic1, 1University Hospital Centre Zagreb, Division of Gastroenterology and Hepatology, Zagreb, Croatia

Background

Establishment of Crohn's disease (CD) phenotype is helpful in predicting disease behaviour and is crucial in designing our management plan. Within heterogeneous family of disease manifestations considered as CD, diffuse jejunoileitis, although unrecognized as a unique subtype, is associated with high morbidity and represents a true therapeutic challenge. The aim of our study was to assess distinctive features of its behaviour.

Methods

Our study evaluated disease location and disease behaviour in 306 patients (pts) with established CD, hospitalized at our Department from January 2004 to October 2012. Data were extracted from their medical records and patients were classified according to the Montreal classification. Regarding disease location they were categorized into three major categories: terminal ileum (L1), colon (L2) and ileocolon (L3). Upper GI location (L4) was added to the latter or, in case of four patients, regarded as a separate category. Patients were further divided in two groups depending on jejunoileal involvement. Perianal disease, if present, was specified. Basic descriptive statistics, including percentiles and medians, were used to interpret results.

Results

In a cohort of 306 CD patients we identified 51 pts (16.6%) with upper GI location. Diffuse jejunoileitis was diagnosed in 11 pts (5 (45.5%) male, 6 (54.5%) female) with upper GI involvement and median age at the time of IBD diagnosis was 28 years (range 3–54). Eight of these patients had terminal ileum affected, three had isolated jejunoileal disease. This group had neither concomitant perianal disease nor colonic lesions present. A group of 40 pts without diffuse jejunoileitis included 19 (47.5%) male and 2 (52.2%) female pts, with median age at disease onset of 19.5 years (range 9–47). They were attributed with disease location as follows: L1+L4 8 pts (20%), L2+L4 2 pts (5%), L3+L4 29 pts (72.5%), and isolated upper GI (L4) 1 pt (2.5%). Perianal disease (9 pts, 22.5%) was confirmed only in patients with concomitant ileocolitis.

Conclusion

Diffuse jejunoileitis is an important, though uncommon, manifestation of Crohn's disease. The results of our study indicate the absence of perianal and colonic involvement in those affected as well as older age at disease onset when compared to patients with upper GI localization without diffuse jejunoileal disease. Even though, according to Montreal classification, it is not recognized as a unique subtype, we have to be aware of the distinct characteristics it exhibits.