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* = Presenting author

P466 Not all penetrating events are the same: differences and similarities in patients with or without entero-urinary fistulas.

R. Coelho*, F. Magro, S. Lopes, G. Macedo

Centro Hospitalar São João, Gastrenterology, Porto, Portugal

Background

Entero-urinary fistulas (EUF) are a rare manifestation of Crohn's disease (CD) observed in 2-8% of patients. The authors aimed to evaluate the response to treatment of patients with EUF in comparison with others with penetrating and stenosing phenotype (B2 and B3 according to the Montreal classification.

 

ECCOJC jju027 P466 F0001

 

Methods

Retrospective single-center analysis of 21 patients with the diagnosis of EUF. Each patient with EUF was compared with 2 patients with B2 phenotype and 2 patients with B3 phenotype. They were randomly selected from inflammatory bowel disease database (www.gedii.pt) and they had the same extent of disease, smoking status, perianal disease and age at diagnosis.

 

ECCOJC jju027 P466 F0002

 

Results

A total of 105 patients were included: EUF (n=21); B2 group (n=42); B3 group (n=42). Patients with EUF had a median age at diagnosis of 29.0 (IQR: 20.5-37.0) and were followed-up for a median of 11.0 years (IQR: 6.0-19.0). The EUF diagnosis was performed 15.0 months (IQR: 2.0-55.0) after CD diagnosis and all the patients were submitted to surgery, mainly ileocolectomy (71.4%). Comparing B3 group with patients with EUF, the former was more steroid dependent and resistant (52.4% vs. 19.0%, p= 0.009) and needed anti-TNF therapy more frequently (59.5% vs. 28.6%, p=0.016). Moreover, B3 patients had a poorer response to anti-TNF therapy without remission free of steroid therapy in comparison with EUF patients (92.1% vs. 16.7%, p<0.001). EUF patients did not differ from B2 group regarding anti-TNF therapy (p=0.956) and steroid dependence or resistance (p=0.141). The current therapy of patients with EUF is very similar to patients with B2 group (graphic 1) and differ from patients with penetrating phenotype (graphic 2).

Conclusion

Surgery seems to be a good therapy choice for patients with EUF as their response to CD treatment after surgery appears not to differ to B2 patients.