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P443 Clinical features, therapeutic requirements, and evolution of patients with Crohn's disease and upper digestive tract involvement (CROHNEX study)

E. Sainz Arnau*1, Y. Zabana2, I. Miguel3, A. Fernández Clotet4, M. J. Casanova5, M. D. Martín6, M. D. Picó7, E. Alfambra8, I. Rodriguez9, F. Muñoz10, M. Domínguez11, E. Iglesias12, D. Busquets13, A. Gutiérrez14, F. Cañete15, L. Nuñez16, C. Taxonera17, B. Beltrán18, B. Camps19, X. Calvet20, P. Navarro21, M. Calafat22, R. Ferreiro-Iglesias23, C. González-Muñoza24, B. Sicilia25, C. Rodríguez26, A. Y. Carbajo27, M. van Domselaar28, R. Vicente29, M. Piqueras30, M. C. Muñoz31, À. Abad32, A. Algaba33, P. Martínez34, M. I. Vela35, B. Antolín36, J. M. Huguet37, L. Bujanda38, R. H. Lorente39, P. Almela40, M. J. García41, P. Ramírez de la Piscina42, R. Pajares43, I. Pérez-Martínez44, A. J. Lucendo45, O. Merino46, J. Legido47, I. Vera48, V. J. Morales49, M. Esteve2

1Hospital Sant Joan de Déu Althaia - Manresa, Gastroenterology, Manresa- Barcelona, Spain, 2Hospital Mútua de Terrassa, Gastroenterology, Terrassa- Barcelona, Spain, 3Hospital Arnau de Vilanova, Gastroenterology, Lleida, Spain, 4Hospital Clínic de Barcelona, Gastroenterology, Barcelona, Spain, 5Hospital Universitario de la Princesa, Gastroenterology, Madrid, Spain, 6Hospital La Paz, Gastroenterology, Madrid, Spain, 7HGU de Elche, Gastroenterology, Elche- Alicante, Spain, 8Hospital Clínico Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain, 9Hospital de Galdakao, Gastroenterology, Galdakao-Vizcaya, Spain, 10HU Salamanca, Gastroenterology, Salamanca, Spain, 11Hospital San Jorge, Gastroenterology, Huesca, Spain, 12Hospital Reina Sofía, Gastroenterology, Córdoba, Spain, 13Hospital dr. Josep Trueta, Gastroenterology, Girona, Spain, 14HGU Alicante, Gastroenterology, Alicante, Spain, 15Hospital Germans Trias i Pujol, Gastroenterology, Barcelona, Spain, 16Hospital Ramón y Cajal, Gastroenterology, Madrid, Spain, 17Hospital Clínico San Carlos, Gastroenterology, Madrid, Spain, 18Hospital La Fe, Gastroenterology, Valencia, Spain, 19Hospital de Bellvitge, Gastroenterology, Barcelona, Spain, 20Hospital Parc Taulí, Gastroenterology, Sabadell-Barcelona, Spain, 21Hospital Clínico, Gastroenterology, Valencia, Spain, 22Hospital Son Llàtzer, Gastroenterology, Mallorca, Spain, 23Hospital de Santiago, Gastroenterology, Santiago de Compostela, Spain, 24Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain, 25Complejo Hospitalario de Burgos, Gastroenterology, Burgos, Spain, 26Complejo Hospitalario de Navarra, Gastroenterology, Pamplona, Spain, 27Hospital Río Hortega, Gastroenterology, Valladolid, Spain, 28Hospital de Torrejón, Gastroenterology, Torrrejón-Madrid, Spain, 29HU Miguel Servet, Gastroenterology, Zaragoza, Spain, 30Consorci Sanitari Mútua de Terrassa, Gastroenterology, Terrassa-Barcelona, Spain, 31Hospital de Basurto, Gastroenterology, Basurto-Bilbao, Spain, 32Hospital Viladecans, Gastroenterology, Viladecans-Barcelona, Spain, 33HU de Fuenlabrada, Gastroenterology, Fuenlabrada-Madrid, Spain, 34Hospital 12 de Octubre, Gastroenterology, Madrid, Spain, 35Hospital Nuestra Señora de la Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain, 36Hospital Clínico, Gastroenterology, Valladolid, Spain, 37Hospital General Universitario, Gastroenterology, Valencia, Spain, 38Hospital de Donostia, Gastroenterology, Donostia, Spain, 39Hospital General, Gastroenterology, Ciudad Real, Spain, 40Hospital General, Gastroenterology, Castelló, Spain, 41Hospital Marqués de Valdecilla, Gastroenterology, Santander, Spain, 42HU de Álava, Gastroenterology, Álava, Spain, 43Hospital Infanta Sofía, Gastroenterology, Madrid, Spain, 44HU Central de Asturias, Gastroenterology, Oviedo, Spain, 45Hospital General de Tomelloso, Gastroenterology, Tomelloso-Ciudad Real, Spain, 46Hospital de Cruces, Gastroenterology, Barakaldo-Bilbao, Spain, 47Hospital de Segovia, Gastroenterology, Segovia, Spain, 48HU Puerta de Hierro, Gastroenterology, Majadahonda-Madrid, Spain, 49Hospital General de Granollers, Gastroenterology, Granollers-Barcelona, Spain

Background

Patients with upper (L4) and diffuse (L1 + L4) Crohn's disease (CD) may have a more aggressive and refractory disease course. However, evidence on this particular sub-type of patients is scarce. Clinical guidelines do not offer specific protocols on how to manage them.

Methods

To identify the clinical characteristics, therapeutic requirements and complications that are independently associated with an upper digestive tract CD involvement.

METHODS: Retrospective study of cases and controls matched (1: 2) by sex and age in patients with CD (L4 or L1 + L4: cases; L1 or L3: controls) of the ENEIDA database (49 hospitals). The small intestine was evaluated with radiologic and/or endoscopic examination, and complex perianal disease was excluded. Clinical variables: pattern, severity, anaemia; Complications: stenosis, fistula, abscess, perforation and digestive bleeding; Therapeutic requirements: use of 1 anti-TNF, more than 1 ant-TNF, anti-TNF intensification, second-line biologic drug, iv iron, blood transfusions, enteral nutrition, endoscopic/radiological treatments, surgeries and hospitalisations were investigated. A logistic regression analysis with those significant variables in univariate analysis (SPSS) was performed.

Results

In total, 919 cases and 1838 controls were identified. Multi-variate analysis showed that cases were independently associated to stricturing pattern at diagnose (OR: 1.2, 95% CI: 1–1.5; p = 0.048), iron deficient anaemia (OR: 2.3, 95% CI: 1.6–3.4; p < 0.0001), more extensive involvement ( > 30 cm) (OR: 2.7, 95% CI: 2.3–3.3; p <0.0001), and the use of second-line biologics during follow-up (OR 1.6, CI 95% 1–2.4; p = 0.04). In contrast, they exhibit less abscesses (OR 0.6, 95% CI: 0.5–0.8; p = 0.001) and have less familial history of inflammatory bowel disease (OR 0.7, 95% CI: 0.6 −0.9; p = 0.008).

Conclusion

In the most extensive series of upper digestive tract involvement in CD, it is shown that they present a more advanced disease at CD diagnosis, suggesting either a late diagnosis or different physiopathologic pathways for L4 involvement. Consequently, they are more refractory to treatments, requiring more frequently second-line biologics. A specific diagnostic and therapeutic strategy must be considered for these patients. This includes consider signs that allow a high rate of suspicion such as iron deficient anaemia in patients with normal upper and lower endoscopy.