P638 Stenotic Crohn’s disease

Abstract

Background The treatment of Crohn’s stenosis appears to be codified and complex, it depends on the inflammatory or fibrous type of stenosis. The purpose of our study was to describe the clinical, epidemiological and therapeutic characteristics of Crohn’s disease in its stenotic form and to determine the failure factors for the treatment of stenotic CD. Methods This is a descriptive and analytical monocentric retrospective study, involving 900 Crohn’s patients, 189 of whom had stenotic CD. The statistical analysis is performed using the SPSS 22.0 software. Results The average age was 32± 11 years. Followed for an average of 48 months[12–96].Sex ratio=1.14F/1H. 44(23.3%) were smokers and 29(15.3%) had a previous of appendectomy.Symptomatology was Koenig syndrome in 107 cases(56.6%), occlusive syndrome in 40 cases(21.2%), constipation in 31 cases(16.4%), vomiting in 7 cases(3.7%) and 4 cases(2.2%) asymptomatic.The localisation of stenosis was ileocaecal in 118 patients(62.4%), hail in 32 patients(16.9%), colic in 17 cases(9%), anal in 15 cases(7.9%) and high in 7 cases(3.7%).Stenosis was unique in 160 cases(84.7%) and multiple in 29 cases(15.3%). 117 patients (62%) had a short stenosis <5 cm and 72 patients (38%) had a stenosis >5 cm. The fibrous nature of stenosis was in 86 patients (45.5%) and inflammatory in 103 (54.5%). 40 patients (21.2%) had an associated fistulizing behaviour. Anoperineal manifestations (MAP) in 58 cases (30.7%). Therapeutically speaking:80 patients (42.3%) were treated with corticosteroids, 10 patients (5.3%) with anti-TNFa, 3 patients (1.6%) with immunosuppressants (IS), 12 cases (6.3%) with endoscopic dilation and 84 cases (44.4%) were operated. The course was marked by a good response in 53 cases (28%), the appearance of fistula± abscess in 25 cases (13.2%), intestinal obstruction in 13 cases (6.9%) and recurrence of stenotic disease in 98 cases (51.9%).There is a difference in management between fibrous and inflammatory stenosis:corticosteroids(1.2%vs98.8%),anti-TNF(10%vs90%), dilation(100%vs0%), surgery(84.5%vs15.5%), this difference is statistically significant(p < 0.001). In multivariate analysis and by adjusting for confounding parameters, it appears that only MAP, ileocaecal location and fistulizing behavior are associated with treatment failure with [OR = 3.2; IC = 1.4–7.7; p = 0.005], [OR = 0.17; IC = 0.3–0.9; p = 0.037], [OR = 2.6; IC = 1.02–6.6; p = 0.04]. Conclusion There was a statistically significant difference (p < 0.001) in terms of response to corticosteroid and anti-TNF treatments, as well as the use of surgery and dilatation between fibrous and inflammatory stenosis. And treatment failure was related to: MAP association [OR = 3.2; IC = 1.4–7.7; p = 0.005], ileocaecal localisation of stenosis [OR = 0.17; IC=0.3–0.9; p = 0.037] and fistulizing behavior[OR = 2.6;IC = 1.02–6.6;p = 0.04]