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P379. Predictors of response to medical treatment in Crohn's disease patients with intestinal obstruction

N. Ben Mustapha, A. Labidi, M. Serghini, Y. Kardous, M. Fekih, J. Boubaker, A. Filali, La Rabta Hospital, Gastroenterology A, Tunis, Tunisia

Background

Intestinal striture is a feared complication of Crohn's disease (CD) often resulting in repeated bowel resection. Intestinal obstruction due to inflammatory stricture is expected to be resolved with medical treatment. The aim of our study was to determine predictors of response to medical treatment in CD patients with symptomatic stenosis.

Methods

We retrospectively reviewed patients with stenosing phenotype of CD which were admitted to our department from 2009 to 2012. We included those who had medical treatment for intestinal obstruction. Epidemiologic and clinical features of patients and the course of CD were abstracted from medical records. For each patient we determined reponse pattern, occurrence of complications and need for surgery after medical treatment. Statistical analysis of data was performed with SPSS version 21.0.

Results

We colliged 31 patients (20 males and 11 females) of mean age at CD onset of 29.4 years old (10–60). Intestinal obstruction site was: ileum (n = 30), colon (n = 1) and duodenum (n = 1). Patients were treated with corticosteroids (n = 27), anti-TNF agents (n = 1), aminosalcylates (n = 3). Most of patients had also been put on thiopurines to avoid clinical relapse (n = 17) (54.8%). Patients were followed during a mean period of 15.8 months. There were clinical response in 26 patients (83.8%), 10 from them (32%) had relapsed after a mean time of 5.4 months (1–11) and no response in 3 patients. Complications occurred in 3 patients: abdominal abcess (n = 1), ileal perforation (n = 1) and ileal fistulas without abcess (n = 1). Surgery was performed in 5 patients after a mean 5-month treatment period. Clinical response rate was significantly lower in patients who had vomiting (24% vs 76%, p = 0.04) and higher in those who had been put on thiopurines concomitantly to medical attack treatment (63% vs 37%, p = 0.037). Relapse rate was significantly lower in patients who had been on thiopurines (70% vs 30%, p = 0.037). Patients who underwent surgery after medical treatment presented significantly more frequently with occlusive symptoms (60% vs 40%, p = 0.03).

Conclusion

In CD patients with intestinal obstruction, it is worth trying a medical treatment before undergoing surgery since clinical response rate exceeded 80% in our study. Thiopurines seem to improve response rate to medical treatment, then clinicians should associate it with first medical attack treatment.