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P493 Inflammatory sticturing Crohn’s diseases: results of medical treatment

N. Bellil1, N. Bibani1, M. Sabbah1, D. Trad1, H. Elloumi1, A. Ouakaa*1, D. Gargouri1

1Habib Thameur Hospital, Gastroenterology, Tunis, Tunisia

Background

Stricture is the most common complication of CD. Treatment of stricturing CD depends on the inflammatory or fibrotic character of the stricture. However, therapeutic management of stricturing CD remains a complex situation as it has been shown that inflammatory and fibrosis are two overlapping entities. The aim of our study was to assess the short- and long-term impacts of medical treatment in inflammation stricturing CD and to identify predictors of therapeutic failure and lead to surgery.

Methods

A retrospective study over a period of 15 years (2001–2016) including all patients with CD receiving medical treatment for symptomatic inflammatory stricture was performed. The inflammatory nature of stricture was mainly identified by cross-sectional imaging examinations showing signs of active inflammation. Therapeutic failure was defined as symptomatic recurrence leading to hospitalisation or endoscopic dilation or surgery. Short andlong-term medical therapy failure were defined by occurrence of cited above events within respectively 6 and 24 months after initiation of medical therapy.

Results

Fifty-one inflammatory strictures were collected in 43 CD patients who received medical treatment. Medical therapy was based on a full-dose of oral corticosteroids in 37 cases (73%) and anti-TNF agents in 14 cases (27%). Azathioprine was prescribed in maintenance for patients who received corticosteroids in 21 cases (63%) and in combination with anti-TNF (combotherapy) in 12 patients (85%). The short-term therapeutic failure rate was 22% (n = 11) and the long-term therapeutic failure rate was 45% (n = 23). Nineteen patients (37%) needed surgery within an average of 11 months (7–18 months).

In multi-variate analysis, only the presence of fistulas was associated with short-term medical therapy failure (p = 0.014). Active smoking (HR 3.46, 95% CI [1.129–10.821], p = 0.009), age at diagnosis (A1 according to the Montreal classification) (HR 2.02, 95% CI [0.613–6.715], p = 0.036) and presence of enteroenteric fistulas (HR 7.188, 95% CI [1.804–28.634], p = 0.001) were independent predictors of long-term medical therapy failure and surgery requirement.

Conclusion

Despite the identification of inflammatory nature of intestinal stricture, medical treatment fails in half of the cases and nearly 40% of patients are operated on after 2 years. This emphasises the fact that the two entities, inflammation and fibrosis, cannot be dissociated. Identify predictors of therapeutic failure, may allow us to select from the outset patients at high risk of surgery.