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P292 Perianal disease: far beyond a simple feature of Crohn's disease

Xavier S.*1, Gonçalves T.1, Castro F.1, Magalhães J.1, Moreira M.1, Cotter J.1,2,3

1Hospital da Senhora da Oliveira, Gastroenterology, Guimarães, Portugal 2Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal 3Life and Health Sciences Research Institute/3B's, PT Government Associate Laboratory, Braga, Portugal

Background

Perianal disease is a significant source of morbidity and impairs the quality of life of affected patients with Crohn's disease (CD). We aimed to access the impact of perianal involvement in disease outcomes.

Methods

Retrospective unicentric study including patients with definite diagnosis of CD with a follow up of at least 12 months. All patients with documented perianal disease (anal fistula and perianal abscess) were included while controls were randomly selected. Clinical and analytical variables were assessed, and disease outcomes (hospitalization, surgery, need for steroids and behavior progression) during the follow-up were reviewed. Statistical analysis was performed using SPSS v21.0 and a two-tailed p value <0.05 was defined as indicating statistical significance.

Results

Included 198 patients, of which 53 (26,8%) had perianal disease. Patients had a mean age of 41±13 years and 52,5% were females. When comparing patients with and without perianal disease, no significant differences were found between groups regarding gender, age, Montreal classification at diagnosis (age, location and behavior-excluding perianal involvement), family history and smoking habits. Patients with perianal disease had more frequently proctitis at diagnosis (32.1% vs 5,6%, p<0.01), and this difference was statistically significant. During follow-up, these patients were more frequently submitted to surgery (excluding perianal disease interventions) (41.5% vs 24.8%, p=0.02), were more frequently hospitalized (66.0% vs 49.7%, p=0.04), had longer in-stay (23 days vs 12 days, p=0.01) and were more frequently treated with anti-TNF agents (56.9% vs 38.1%, p=0.02). Also, these patients were more likely to have a change in disease behavior, with development of penetrating disease (18.9% vs 6.9%, p=0.01). No differences were found between the two groups regarding extra-intestinal manifestations, need for steroids, time from diagnosis to first surgery and development of stricturing disease.

Conclusion

Patients with perianal disease had significantly higher disease burden, with greater need for surgery, hospitalization and more frequently displayed penetrating disease progression. These results support that perianal CD represents a particularly aggressive disease phenotype that should be treated aggressively, not only due to the perianal involvement but also, very importantly, because of its association with worse outcomes.