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P223 Oesophagal involvement is a predictor of anti-TNF treatment failure in patients with Crohn’s disease

Y. Sakata, N. Tsuruoka, M. Esaki

Saga Medical School, Internal Medicine and Gastroenterology, Saga, Japan

Background

Oesophageal Crohn’s disease (CD) is rare and not well known. We aimed to determine the clinical features of CD patients with oesophagal lesions seen at our institution.

Methods

Upper gastrointestinal (GI) endoscopy was performed as a routine procedure for the diagnosis of upper GI involvements in CD patients from 2012 to 2018 at Saga University Hospital. CD patients with oesophagal lesions were evaluated for demographics, CD characteristics, endoscopic findings, and treatments.

Results

A total of 68 CD patients underwent upper gastrointestinal endoscopy and 8 patients with oesophagal involvement were identified. The detecting rate of CD specific lesion in the oesophagus by endoscopy was 11.8%. 7 out of 8 patients were male and average age is 27 years (range, 18–61 years). Extraesophageal lesions included three types of CD (3 patients with ileitis, 3 patients with colitis, and 2 patients with ileocolitis) were found. 6 patients (75%) had oral ulcers at the time of oesophageal CD symptom onset. Four patients (50%) complained of retrosternal pain as an oesophageal-specific symptom and other patients complained of loss of appetite. Endoscopic findings showed small, round, superficial ulcerations in 4, and deep longitudinal ulcerations in 4. Superficial ulcerations were found throughout the entire oesophagus. No patients were found to have oesophageal strictures and fistulizing disease. 5 out of 8 patients (62.5%) developed loss of response (LOR) to anti-TNF treatment. Incidence of LOR in CD patients with oesophageal involvement was significantly higher compared with patients without oesophageal involvement (odds ratio 6.67, 95% CI 1.23–36.06, p = 0.031).

Conclusion

Although oesophageal lesions of CD have been regarded as uncommon in adults, it has become increasingly recognised. The oesophageal CD should be considered in all CD patients complaining of upper gastrointestinal symptoms. Oesophageal involvement in CD patients predicted LOR to anti-TNF treatment.