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P314 Management of perianal disease in patients with Crohn's disease

Algaba A.*1, Rubín de Célix C.1, Guerra I.1, Serrano A.2, Pérez-Viejo E.2, Aullό C.3, Hernández-Tejero M.1, Granja A.1, Bermejo F.1

1Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain 2Hospital Universitario de Fuenlabrada, Surgery, Fuenlabrada, Spain 3Hospital Universitario de Fuenlabrada, Radiology, Fuenlabrada, Spain

Background

Perianal disease (PD) in patients with Crohn's disease (CD) can determine the treatment and it is cause of substantial morbidity. Our aims were to describe the multidisciplinary management of patients with CD and associated PD and to analyze the possible relationship between PD relapse and the type of fistula and treatments used

Methods

Retrospective case series study. Epidemiological and clinical data were collected from each patient. The type of fistula was determined by Parks classification. Complete response was defined as closure of the fistulous orifice and cessation of drainage in all fistulas and partial response as cessation of drainage in at least 50% of fistulas

Results

66 patients with PD from a total of 300 patients with CD were included; 56% men, mean age: 44±12 y, 48% smokers. The mean time to diagnosis of PD was 43.1 months, although in eight patients (12%) the fistula diagnosis was prior to the diagnosis of CD. 13 fistulas were simple (28% superficial, 32% intersphincteric, and 40% low transsphincteric) and 49 were complex (15.9% low fistulas with proctitis or multiple external openings, 34.2% high transsphincteric, 26.3% suprasphincteric, 15.7% extrasphinteric and 7.9% rectovaginal). 79% of the patients had associated perianal abscess at diagnosis. Regarding the treatment used, 51 patients (77.4%) were treated with antibiotics (metronidazole, ciprofloxacin and levofloxacin, 91.5% with improvement of symptoms), 59 patients (89%) required immunomodulators (49 after diagnosis of PD) and 34 patients needed anti-TNF treatment (n=32, 94% of cases). The first line biological drug was infliximab (n=32, 94% of cases) with complete response in 14 patients (43.7%), partial response in 6 patients (18.7%) and unresponsive in 12 patients (37.5%, 9 of these patients were switched to adalimumab 3, of them with complete response). Surgery was required in 49 patients (75.4%) and in 24 of them (49%) setons were used, most of them (73.7%) for more than 12 months. Fistulotomy was used in both simple (33.3%) and complex fistulas (29.4%) with a complete response in 62.8% of the cases treated with this technique. Globally, 46.6% of patients had recurrence of PD. Patients with complex fistulas required more frequent surgical treatment (p=0.012) and had more recurrence (p=0.036). Significant differences between PD recurrence and sex, age at diagnosis or smoking were not found

Conclusion

Half of the patients require anti-TNF drugs to control PD, these patients present a more complex PD and with more recurrences. Despite the relapses, the effectiveness of biological drugs is acceptable in this type of patients, showing the importance of multidisciplinary and combined treatment (antibiotics, immunomodulators, biological drugs and surgery)