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

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. 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. 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). 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.