P209 Impact of perineal fistulization on behavior characteristics of intestinal crohn's disease
N. Bounab*1, L. Kecili1, A. Balamane1, A. Bousseloub2, K. Belhocine1, K. Layaida1, N. Kaddache1, L. Gamar1, T. Boucekkine1, S. Berkane1
1CHU Mustapha, Faculty of Medicine, Algiers, Algeria, 2Hôpital Central de l'armée , Faculty of Medicine, Algiers, Algeria
Fistulization, either intra abdominal or perianal is one of the most prominent characteristics of Crohn's Disease (CD); relationships between these two sites of penetrating disease need to be evaluated.
To assess the influence of fistulizing perianal CD phenotypical characteristics and long term outcome of abdominal disease we have studied a cohort of 169 consecutive cases of CD enrolled at diagnosis from 01/01/2005 to 31/12/2008 and prospectively followed-up until 31/12/2013 (mean duration of follow-up 6,9 years). All patients underwent initial complete investigation. A systematic clinical control with endoscopy or radiology when needed was performed every 6 or 12 months, and on demand. Statistical study : Students Fisher's t test and Mann Whitney's U test
59 patients presented with perianal fistulizing disease (GI=34,9%), 18 at diagnosis and 41 during the follow-up and 110 had no anal disease (GII : 65,2%). Comparison of those 2 groups of patients didn't show any Statistical Significant Difference (SS as regards to : 1/mean age at diagnosis (GI : 31,3y Vs GII: 30,9y) ;2/gender : (SR : F/M : GI : 1,1 Vs GII: 1,1); 3/ Duration of disease before diagnosis (GI : 11,6 months Vs GII: 13,4 months); 4/ Occurrence of familial disease (GI : 8,4%Vs GII: 8,2); 5/Smoking habits (GI : 33,9%Vs GII: 33,6%) ; 6/ extra intestinal disease (GI : 17%Vs GII: 17,3%). In GI patients : 1/ colonic location of lesions was more frequent (GI : 33,3%Vs GII: 19,2 : p = 0,0698) ; 2/ Intestinal fistulazing disease was more frequent as well at diagnosis (GI : n=5/18 27,8%Vs GII: n=28/151 : 18,6% ;p 0,5382) as at the end of follow up (GI : n=20/59 : 33,9% Vs GII: n=20/110: 18,2% ; p = 0.0358) ; 3/intestinal flares were more frequent (GI : 0,8 Vs GII : 0,7); 4/ Some intestinal complications were more frequent : abcess (GI : 20,2%Vs GII: 4,5%) ; p = 0,0029) , fistulas (enteroenteral (GI : 11,7%Vs GII: 5,4% ; p = 0,2425) ; enterovesical (GI : 3,4%Vs GII: 0,9%; p = 0,5737) , enterocutaneous : (GI : 6,8%Vs GII: 3,6% ;p = 0,5790) 5/Need for intestinal resection (GI : 38,9%Vs GII: 32,7%; p = 0,5242); and number of a second surgical procedure (GI : 20,3%Vs GII: 12,7%; p = 0,2790); and a third one (GI : 8,5%Vs GII: 2,7%;p = 0,1889).
The Results of that prospective study support the view that perianal fistulization in CD is strongly associated with severe penetrating and complicated intestinal disease.