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P395. Perianal Crohn's disease - Experience of a tertiary referral center

S. Fernandes, P. Sousa, M. Moura, L. Correia, A. Rita Gonçalves, P. Moura Santos, A. Valente, C. Baldaia, J. Velosa, Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal

Background

Crohn's disease (CD) is a form of inflammatory bowel disease with the potential to affect every segment of the digestive tract. Perianal disease is a recognized indicator of poor prognosis with significant negative impact on quality of life and need for surgery.

Methods

We conducted a retrospective review of 466 patients with CD under hospital follow-up and determined the prevalence of perianal disease. Response to azathioprine (AZA) and anti-TNF therapy (12, 36 and 60 months) was determined.

Results

22% had perianal disease with a mean age of onset at 31 years. Most had ileocolic or ileal disease (57.7% and 21.4%) and inflammatory or penetrating patterns (58.3% and 52.9%). In 52% perianal disease was the first manifestation of CD. The first presentation was most often a fistula (44.7%), abscess (35.9%), fissure (18.5%) or ulcer (1%). Most patients later developed fistulizing perianal disease (71.8%, 19% complex). 9% and 12% developed rectovaginal fistulas and anal stenosis respectively. 5 patients required a colostomy in order to control perianal disease and in 2 it was permanent. 80% and 59% received treatment with AZA or anti-TNF (82.8% Infliximab and 17.2% Adalimumab) with 34% and 45% achieving response. Response rates for anti-TNF decreased over time (72%, 70% and 59% at 12, 36 and 60 months). The percentage of responders did no differ significantly between patients with anti-TNF or anti-TNF combined with AZA (40% versus 55% p = 0.36). When compared with patients without perianal disease, age at diagnosis was lower (3 years, p < 0.05) and anti-TNF therapy was used more often (55% versus 27% p < 0.01). There was no statistically significant difference in the need for bowel surgery or use of combined therapy between patients with and without perianal disease (26.9% versus 27.2% and 32.0% versus 33.0%, respectively).

Conclusion

Perianal disease is common in CD. It is associated with severe phenotypes, major complications and early need for anti-TNF therapy. The response to azathioprine and anti-TNF therapy is satisfactory but seems to decrease over time.