A Comparison of the Epidemiology and Natural History of Chronic Stenosing Enteritis and Crohn’s Disease: 344

Introduction: We have previously described chronic stenosing enteritis (CSE), a disorder notable for large indolent superficial ulcers and stenoses in the mid small intestine resulting in iron deficiency anemia. The goal of this study is to investigate the natural history and epidemiology of CSE as compared with Crohn’s disease (CD). Methods: Between 2007 and 2013, our group identified and surveyed 14 patients with CSE based on the predominant signs and symptoms of iron deficiency anemia, obscure GI bleeding, abdominal pain, and lack of diarrhea. Nine patients with concurrently diagnosed small bowel CD were surveyed as controls. Patients were questioned regarding symptom severity, treatments and outcome, employment, and travel history. This study was approved by the Institutional Review Board at UMass Medical Center. Statistical analysis utilized 2-sample t-tests to determine significance. Results: Data demonstrated a significantly different mean age of symptom onset for CSE and CD (49.4 vs. 28.0 years old; p=0.01). Symptoms most commonly reported in CSE were abdominal pain and blood in stool; CD patients reported more diarrhea and abdominal pain. Symptoms were reported to be significantly more severe by CD patients than for CSE patients (9.3 vs. 7.3 on a 1-10 scale; p=0.03), and were also more frequent in CD compared to CSE (120 vs. 20 times per month; p=0.05). Most CD patients were treated with anti-TNF agents, whereas CSE patients were treated with intravenous or oral iron supplements. In the CD cohort, 44% of patients were placed on anti-TNF agents before surgery; 22% had a small bowel resection (SBR); 0% had recurrence following SBR. In the CSE cohort, 28% of patients were placed on anti-TNF agents after SBR; 50% had SBR, 57% of those patients had recurrence. In regards to employment, 29% CSE patients were engineers compared with 0% CD patients. Of the CD patients, 0% described their highest level of occupation as “managerial” or “executive,” compared with 42% of CSE patients. Travel history was also more extensive for CSE patients with an average of 36.2 trips abroad their lifetime compared with 0.89 trips for CD patients. Conclusion: CSE is a rare and separate entity from CD. Our study demonstrates several characteristics that differ between these 2 conditions, including symptom type, frequency, severity, age distribution, social status, and travel history. The differences and social status and the travel histories noted suggest different environmental factors may play a role in their etiology and/or pathogenesis.