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P221 Natural history of perianal Crohn's disease in patients with elderly-onset disease: a population-based study

Danielou M.*1, Mamona C.2, Barthoulot M.2, Pariente B.3, Fumery M.4, Sarter H.5, Charpentier C.1, Dupas J.-L.6, Savoye G.1, Gower-Rousseau C.2

1CHU Rouen, Department of Gastroenterology and Hepatology, Rouen, France 2CHRU Lille, Department of Epidemiology, EPIMAD Registry, Lille, France 3CHRU Lille, Department of Gastroenterology, Lille, France 4Amiens University Hospital, Department of Gastroenterology and Hepatology, Amiens, France 5CHRU Lille, Department of Biostatistics EA 2694, Lille, France 6Amiens University Hospital, Hepatogastroenterology, Amiens, France

Background

Population-based studies usually described a mild course of elderly-onset (>60 years) Crohn's disease (CD). However the natural history of perianal CD in this population is unknown. We aimed to describe the prevalence and the natural history of perianal CD in patients diagnosed with CD after 60 years.

Methods

All patients diagnosed with CD after the age of 60 years between 1988 and 2006 were included (n=372). Perianal CD was defined by a perianal abscess or fistula and was classified according to Cardiff classification. Logistic regression and Cox model were used to identify factors associated with perianal CD.

Results

Thirty-four patients (34/372, 9%) were diagnosed with perianal CD at diagnosis. After a median follow-up of 5.4 years [Interquartile range, 2.0–10.1], a total of 59 patients (59/372, 16%) were diagnosed with perianal CD. The 5-year cumulative probability of perianal CD was 17% [CI 95%, 13–21]. Thirty-nine percent of patients (23/59) had complex fistula. At the end of follow-up, incontinence was observed in 22% of patients with perianal CD as compared to 4% of patients without perianal CD (p=10–4). Perianal CD at diagnosis was significantly associated with 5-years immunosuppressants exposition (29.6% [9.8–45.1] vs 16.6% [12.0–21.0]; p=0.02) and with intestinal resection (54.2% vs 29.4%; p<10–3). Twenty-four percent of patients with perianal CD had definitive stoma as compared to 4.5% of patients without perianal CD (p<10–2). At diagnosis, rectal disease was significantly associated with perianal CD occurrence (Odds Ratio, 2.3 [95% CI, 1.1–4.8]). During follow-up, both isolated rectal disease (OR, 2.9 [95% CI, 1.6–5.0] and pure colonic location (L2) (OR, 8.7 [95% CI, 1.2–63,4] were significantly associated with perianal CD occurrence.

Conclusion

In a large elderly-onset population-based cohort, about 20% of patient had perianal CD. The occurrence of perianal CD was associated with pure colonic location and rectal involvement. Although these patients have received more frequently immunosuppressants, one-quarter had definitive stoma, emphasizing the value of early biologic therapy in these patients.