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P394 Contribution of the CDEIS in the new therapeutic approach of Crohn's disease

A. Sabbek*1, N. Elleuch2, A. Ben Slama2, E. Hammami2, H. Jaziri2, A. Braham2, S. Ajmi2, M. Ksiaa2, A. Jmaa2

1Sahloul Sousse, Gastroenterology, Sousse, Tunisia, 2Sahloul Sousse, Sousse, Tunisia

Background

Deep remission, currently considered the major goal in Crohn's disease (CD), as well as the emergence of the concept of treating beyond symptoms, leads that colonoscopy has become the cornerstone in assessing the severity of lesions to guide the therapeutic decision. As a result, the Crohn’s disease endoscopic index score (CDEIS) makes possible the use of a common language to standardise the reports and therefore to comply with a codified treatment. The purpose of our work is to evaluate the contribution of the CDEIS in the CD by studying the attitudes adopted by clinicians and comparing them to those that would have been appropriate by referring to the CDEIS after treatment.

Methods

A retrospective study spread over 5 years, collecting patients diagnosed with a CD at the gastroenterology department of Sousse. The first relapse has been studied. CDEIS after treatment was calculated. The endoscopic response was defined by a reduction of the CDEIS of more than 50% while the endoscopic remission by a score <3. The criteria of non-inclusion were the complications which necessitated an emergency surgical treatment without endoscopy. Three groups were individualised: Group 1: CDEIS < 3 (n = 9); Group 2: decrease of the CDEIS > 50% (n = 72); Group 3: decrease of the CDEIS <50% (n = 28).

Results

We collected 135 patients of mean age 38.6 years and sex ratio of 0.43. Induction of remission was based on intravenous corticosteroids in 22.9% and oral in 66.6% while TNF-α antagonists was used in 10.3% of cases. The clinical remission was obtained in 80.7% and in this case, the maintenance of remission was based on azathioprine in 74.3%, combotherapy (TNFα antagonists + azathioprine) in 16.5% and an TNF-α antagonist alone in 9.1% of cases. Colonoscopy after treatment was performed in a mean time of 14.7 months. Endoscopic remission was obtained in 11% and a response in 66% of cases. In the first group, no therapeutic modification was performed while the clinician opted for a therapeutic escalation in the second group in 11.1%. For the third group, a more aggressive therapeutic attitude was achieved in 32.1%. In univariate analysis, the specific complications of the disease (intraabdominal abscess, bowel obstruction, perforation) were significantly more frequent in the third group compared with the second for an average duration of follow-up of 2.4 years (25% vs. 16.6%, p = 0.03).

Conclusion

In our study, our therapeutic attitude was more conservative than the appreciation of the CDEIS in 17.4% of cases. Certainly, the intuition of the clinician is very important but the CDEIS, allows a more objective assessment of endoscopic lesions and therefore a better management aimed at modifying the natural history of the disease.