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P415 Predictive factors of a subsequent ano-perineal abscess in patients with fistulising ano-perineal Crohn’s disease in remission

P. Rivière1, A. Malian1, D. Bouchard2, F. Pigot2, M. Eleouet-Kaplan2, C. Favreau-Weltzer2, F. Poullenot1, D. Laharie1

1Bordeaux University Hospital, Gastroenterology and nutrition, Bordeaux, France, 2Bagatelle Health Center, Proctology, Bordeaux, France

Background

Fistulising ano-perineal (FAP) lesions occur in more than 20% of patients with Crohn's disease (CD). Despite advanced surgery techniques and anti-tumour necrosis factor (anti-TNF) agents use, relapse rate of FAP-CD remains 30%. The objective of the present study was to identify predictors of a subsequent ano-perineal abscess in patients with FAP-CD in remission.

Methods

We conducted a retrospective study including all consecutive FAP-CD patients achieving clinical ano-perineal remission between 2007 and 2015 in one referral centre. Remission was defined by the absence of any draining fistula or abscess within 3 months after the last drainage surgery. Patient characteristics were collected at drainage, at 3 months – corresponding to the inclusion date - and during follow-up. Primary outcome was the occurrence of a subsequent ano-perineal abscess related to FAP-CD and confirmed by examination under anaesthesia and/or MRI. Predictive factors of subsequent abscess were determined in anti-TNF naïve and anti-TNF treated populations.

Results

One hundred and thirty-seven patients (57% female, median age 35 years) corresponding to 157 abscesses [120 (76.4%) treated by anti-TNF at inclusion] were included. Patients not treated by anti-TNF at inclusion were significantly older (40 years vs. 34 years, p = 0.005) and had more often simple fistulas [10 (29%) vs. 66 (58%), p = 0.004]. During the follow-up period [median duration of 43 (IQR 26–63) months], 35 (22%) experienced a subsequent abscess, which occurred within a median time of 1.8 years. Survival without abscess was 96.7% at 1 year, 78.4% at 3 years and 74.4% at 5 years. In the subgroup of 120 patients treated with anti-TNF agents (84 infliximab and 36 adalimumab) at inclusion, ileo-colonic (OR 5.19, p = 0.017) location, stricturing phenotype (OR 5.32, p = 0.013) and discontinuation of anti-TNF therapy during the follow-up period (OR 3.37, p = 0.049) were associated with a subsequent abscess in multi-variate analysis. Conversely, discontinuation of immunosuppressive therapy was associated with a reduced risk of a new abscess (OR 0.22, p = 0.29). Neither the type of anti-TNF agent nor combotherapy use were associated to FAP-CD relapse.

Conclusion

In CD patients with fistulising ano-perineal disease achieving remission, survival without subsequent abscess was approximately 75% at 5 years. Colonic disease location, stricturing phenotype and discontinuation of anti-TNF therapy were associated with a higher risk of new abscess.