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P284 Jejunal Crohn’s disease: characteristics, detection rate, outcome, and need of immunomodulators in a retrospective single-centre study

A. Ruffa1, C. Petruzziello2, E. Angelucci3, G. Sica4, S. Onali3, A. Rossi2, E. Calabrese2, E. Lolli3, F. Pallone3, L. Biancone*5

1University ‘Tor Vergata’ of Rome, Department of Systems Medicine, Rome, Italy, 2University ‘Tor Vergata’ of Rome, Italy, Department of Systems Medicine, Rome, Italy, 3University ‘Tor Vergata’ of Rome, Department of Systems Medicine, Roma, Italy, 4University ‘Tor Vergata’ of Rome, Surgery, Roma, Italy, 5University, Department of Systems Medicine, Rome, Italy

Background

The natural history of Crohn’s disease (CD) of the jejunum is undefined. In a retrospective, single-centre study, we aimed to assess clinical characteristics and outcome of all patients (pts) with jejunal CD referring at our tertiary IBD centre. Whether the detection rate of jejunal lesions in CD has increased during the last few years was also investigated.

Methods

Clinical records of all CD pts followed-up from 2000–2015 (≥ 1yr) were retrospectively reviewed. Clinical characteristics were prospectively recorded:, including gender, age, and CD; behaviour, B1, B2, B3 (Montreal class); CD duration (yr), CD-site (ileum, I:L1; colon,C:L2;I+C:L3; jejunum+I with/without C); surgery (Y/N/,≥1), smoking status; perianal (PA) CD; appendectomy; steroid-(CS) dependence (all Y/N); immunosuppressors (IS;AZA/6MP/MTX); and biologics (IFX, ADA). Statistic data expressed as median (range), Fisher exact, and Chi-square tests.

Results

From 2000 to 2015, 57 pts with jejunal CD were identified (23 [40.3%] M; 34 [59.7%] F; age 44 [17–71]; age at diagnosis of CD (27 [12–66] CD duration 12 yr [1–36]). Lesions at diagnosis of CD included jejunum+I, n = 34; jejunum+C, n = 3; and I with/without, C n = 20). Current lesions included jejunum+I, n = 41; jejunum+C, n = 6; and I with/without C, no jejunum, n = 10. Overall, 42/57 (73.7%) pts required any intestinal surgery, and 21/57 (36.8%) required jejunal surgery. Behaviour in jejunal CD, B1 n = 13, B2 = 36, B3 = 8, is B2 correlated with the need of any intestinal surgery (p = 0.016 and p = 0.023 for 0 vs ≥ 1 and ≤ vs ≥ 1), but not of jejunal surgery (p = 0.10). Perianal CD was observed in 18 (31.6%) pts, being correlated with the need of any intestinal surgery (p = 0.025), but not of jejunal surgery (p = 0.71), familial IBD (p = 0.07), or smoking (p = 0.97). Age at diagnosis was correlated with IS (p = 0.0018), whereas the relation between IS and CD behaviour was at limit of significance (p = 0.055). The detection rate of jejunal lesions (but not of CD) significantly increased during follow-up (1979–89; 1990–1999; 2000–2009; 2010–2005; p < 0.0001; Figure 1a) being significantly more frequent after vs before 2000 (p = 0.001; Figure1b). Jejeunal CD was correlated with the need of surgery (p = 0.0016 surgery ≤ vs > 1; p = 0.022 surgery 0 vs ≥ 1). Therapies: CS in 50/57 (87.7%; B1, n = 12; B2, n = 31; B3, n = 7), IS in 24/57 pts (42%) (B1, n = 2; B2, n = 17; B3, n = 5), anti-TNFs in 17/54 (29.8%) jejunal CD pts (B1, n = 4; B2, n = 11; B3, n = 2).

Figure 1. (a) The diagnosis of jejunal lesions in CD significantly increased during follow-up (1979–1989; 1990–1999; 2000–2009; and 2010–2005; p < 0.0001); (b) being more frequent after vs before 2000 (p = 0.001).

Conclusion

In a cohort of CD pts, the detection rate of jejunal lesions (but not of CD) significantly increased during the last few decades. New imaging techniques may be involved in this finding. Two third of pts required intestinal surgery, including jejunal surgery in one third of patients.