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P306 What is the impact of perianal disease on anorectal function and quality of life of IBD patients? A prospective observational study

Litta F.*1, Scaldaferri F.2, Parello A.1, Zinicola T.2, Gasbarrini A.2, Ratto C.1

1Catholic University of the Sacred Heart, Proctology Unit, Rome, Italy 2Catholic University, Institute of Medical Pathology, Rome, Italy

Background

The perianal disease is a common feature of patients affected by inflammatory bowel disease (IBD), with a detrimental effect on quality of life (QoL). The anorectal function of IBD patients is still poorly understood, with contrasting results. Aim of this prospective observational study was to analyze the effect of perianal disease on anorectal function and QoL of IBD patients, and to compare the results with healthy volunteers.

Methods

Patients were assessed by a full clinical examination (including the Wexner score, the Harvey Bradshaw score, the Clinical Mayo score), anorectal manometry, three-dimensional endoanal ultrasound (3D-EAUS), and endoscopy. The Inflammatory Bowel Disease Questionnaire (IBDQ) was adopted to evaluate patients' QoL.

Results

From January to November 2016, 37 IBD patients (21 males; mean age 40.6±14.0 years) and 20 healthy volunteers (9 males, mean age 46.9±15.1 years) were enrolled in the study. Thirty patients were affected by Crohn's disease (CD), and 7 by ulcerative colitis (UC), with a mean Harvey Bradshaw score and a mean Clinical Mayo score of, respectively, 4.5±3.9 and 3.3±2.9.Twenty-nine patients had a history of perianal fistula, 9 patients were affected by fecal incontinence (mean Wexner score 7.2±4.3), 2 patients by anal fissure. Fecal incontinent patients were older (p=0.025), had a longer duration disease (p=0.015), and a higher bowel movements number (p=0.006) than continent patients. A perianal fistula was more frequent in CD patients (p=0.014), and in smoking patients (p=0.018). The 3D-EAUS was normal in all healthy volunteers, while 31/37 IBD patients had some pathological features (fistula, sphincter lesion, fibrosis). At the anorectal manometry, the maximum anal resting pressure, the maximum squeeze pressure, and rectal sensations did not differ between IBD patients and the control group; however the rectoanal inhibitory reflex was present in all healthy volunteers, and only in 32/37 IBD patients (p=0.080); 25/37 IBD patients had a dyssynergic defecation pattern. No differences emerged at the anorectal manometry between CD or UC patients, while the presence of rectal inflammation (p=0.046) and incontinence (p=0.050) were associated to a lower maximum anal resting pressure. Overall, the mean IBDQ score was 167.6±38.8, but it was lower in UC patients when compared to CD patients (132.5±44.4 versus 170.4±32.9, p=0.018); the QoL score was significantly lower in fecal incontinent patients (146.4±27.9 versus 173.6±39.8, p=0.040).

Conclusion

The anorectal manometry and the 3D-EAUS are useful tools to evaluate IBD patients with a perianal complaint. The anorectal function of IBD patients with a perianal disease is impaired. Patients' QoL is lower in UC, and in fecal incontinent patients.