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P338 Long-term complications in patients with fistulising Crohn’s disease

S. Vuyyuru*1, S. Kedia1, P. Sahu1, S. Bopanna1, S. Jain1, G. Makharia1, V. Ahuja1

1All India Institute Of Medical Sciences, Gastroenterology, New Delhi, India

Background

Fistulisng Crohn’s disease is most severe form of disease behaviour in patients with Crohn’s disease (CD) and is associated with high morbidity. Long-term follow-up data on disease course are lacking from Asian countries. We retrospectively analysed CD patients with fistulising behaviour for long-term complications under inflammatory bowel disease (IBD) clinic follow-up from a single centre.

Methods

Medical records of 807 CD patients diagnosed between 2005 and 2018 were screened for fistulising behaviour, including perianal and non-perianal fistulas as identified by clinical or radiological methods. Total of 100 patients with fistulising CD were included in analysis

Results

Among all patients (mean age 30.3 ± 13.25 years, males: 71%, mean duration of follow-up: 3.5 years), perianal fistula was the commonest (57%), followed by entero–enteric fistula (20%), entero-vaginal (6%), entero-vesical (3%) and entero-cutaneous (8%) fistula. More than 2 types of fistulas were seen in 10% patients. Majority had complex perianal fistula and 46% of them had perianal collections. Diarrhoea was the most common presenting symptom (49%) followed by abdominal pain (24%) and perianal symptoms (13%). Colonic involvement was seen in 81% patients (L2 = 44%, L3 = 37%). Perianal fistula without involvement of rectal mucosa (rectal sparing) was observed in 8% cases. Extra intestinal manifestations were seen in 21% of patients. Most of the patients received multiple courses of antibiotics and none of the patient had complete response. Fifty per cent of patients were on immunomodulatory therapy including azathioprine/6-mercaptopurine and methotrexate. Thirty-six per cent patients were treated with biologicals (infliximab 22, adalimumab 6, both 8). Clinical response was achieved in 72% of patients. Four patients responded to addition of second biological. Interestingly, high percentage (42%) of patients had history of anti-tubercular therapy. Five patients underwent VAAFT (Video Assisted Anal Fistula Treatment) surgery. Twelve per cent patients required diversion procedure in view of non-response to medical or surgical therapies. Long-term complications like anal canal strictures were seen in 8% cases. One patients developed colorectal malignancy in perianal fistula and one patient developed adenocarcinoma from the site of entero-enteric fistula. Four patients expired during follow-up.

Conclusion

Patients with fistulising CD have a complicated disease course, characterised by increased risk of anal strictures, malignancy, mortality and surgery. Biologics are associated with moderate response rates in patients with fistulising CD.