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* = Presenting author

P304 Patients with perianal Crohn’s disease have poor disease outcomes after primary bowel resection

Y. M. Han*1, J. W. Kim2, J. H. Kim1, S.-J. Koh2, H. Yoon3, C. Lee4, J. P. Im1, J. S. Kim1

1Seoul National University College of Medicine, Department of Internal Medicine and Liver Research Institute, Seoul, South Korea, 2Seoul National University Boramae Hospital, Department of Internal Medicine, Seoul, South Korea, 3Seoul National University Bundang Hospital, Departments of Internal Medicine, Seongnam, South Korea, 4Healthcare System Gangnam Centre, Seoul National University Hospital, Department of Internal Medicine, Division of Gastroenterology, Seoul, South Korea

Background

A majority of patients with Crohn’s disease experience recurrence after their first operation. The presence of perianal disease in Crohn’s disease patients is one of the factors of postoperative recurrence. The aim of this study is to evaluate long-term prognosis of perianal Crohn’s disease patients.

Methods

Patients with Crohn’s disease who had undergone surgical bowel resection were divided into 2 groups according to the presence of perianal lesion. Baseline characteristics, disease location, disease activity, extraintestinal manifestation, and presence of granuloma were evaluated. We monitored the occurrences of abdominal and/or perianal reoperation and readmission because of disease flare-up, and these disease outcomes were compared between the 2 groups. Further, factors affecting reoperation and readmission were analysed.

Results

The 132 patients included in the study were divided into 2 groups, those with perianal disease (45 patients, 34.1%) and those without perianal disease (87 patients, 65.9%). Patients with perianal disease were younger in age (33.84 years vs 39.77 years, p = 0.015) and had been diagnosed as CD at a younger age (21.9 years vs 28.6 years, p = 0.005) compared with patients without perianal disease. Patients with perianal disease showed more extraintestinal manifestation than patients without perianal disease (8 vs 3, p = 0.008) did. Reoperation was required in 46 (44.8%) patients during the follow-up period. The cumulative rates of abdominal and/or perianal reoperation were higher in patients with perianal disease than those without perianal disease (p = 0.001).

Figure 1. Comparison of readmission rates according to the presence of perianal disease.

The presence of perianal disease independently increased the risk of reoperation (hazard ratio [HR], 3.061; 95% confidence interval [CI] 1.665–5.628). Further, patients with perianal disease had increased risks of abdominal reoperation when analysis was performed excluding perianal reoperation (HR 2.054; 95% CI, 1.064–3.068).

Figure 2. Univariate and multivariate cox regression analysis of risk factors for abdominal reoperation.

Conclusion

Patients with Crohn’s disease and perianal lesions had a higher risk of reoperation compared with controls. Considering these findings, physicians should consider aggressive and early top-down therapy for patients with perianal Crohn’s disease.