P284. Jejunal Crohn`s disease: characteristics, detection rate

Abstracts of the 11th Congress of ECCO - European Crohn’s and Colitis Organisation
P284
Jejunal Crohn’s disease: characteristics, detection
rate, outcome, and need of immunomodulators
in a retrospective single-centre study
A. Ruffa1, C. Petruzziello2, E. Angelucci3, G. Sica4, S. Onali3,
A. Rossi2, E. Calabrese2, E. Lolli3, F. Pallone3, L. Biancone*5
1
University ‘Tor Vergata’ of Rome, Department of Systems Medicine,
Rome, Italy, 2University ‘Tor Vergata’ of Rome, Italy, Department of
Systems Medicine, Rome, Italy, 3University ‘Tor Vergata’ of Rome,
Department of Systems Medicine, Roma, Italy, 4University ‘Tor
Vergata’ of Rome, Surgery, Roma, Italy, 5University, Department of
Systems Medicine, Rome, Italy
Background: The natural history of Crohn’s disease (CD) of the jejunum is undefined. In a retrospective, single-centre study, we aimed to
assess clinical characteristics and outcome of all patients (pts) with
jejunal CD referring at our tertiary IBD centre. Whether the detection rate of jejunal lesions in CD has increased during the last few
years was also investigated.
Methods: Clinical records of all CD pts followed-up from 2000–
2015 (≥ 1yr) were retrospectively reviewed. Clinical characteristics
were prospectively recorded:, including gender, age, and CD; behaviour, B1, B2, B3 (Montreal class); CD duration (yr), CD-site (ileum,
I:L1; colon,C:L2;I+C:L3; jejunum+I with/without C); surgery
(Y/N/,≥1), smoking status; perianal (PA) CD; appendectomy; steroid-(CS) dependence (all Y/N); immunosuppressors (IS;AZA/6MP/
MTX); and biologics (IFX, ADA). Statistic data expressed as median
(range), Fisher exact, and Chi-square tests.
Results: From 2000 to 2015, 57 pts with jejunal CD were identified (23 [40.3%] M; 34 [59.7%] F; age 44 [17–71]; age at diagnosis of CD (27 [12–66] CD duration 12 yr [1–36]). Lesions at
diagnosis of CD included jejunum+I, n = 34; jejunum+C, n = 3;
and I with/without, C n = 20). Current lesions included jejunum+I,
n = 41; jejunum+C, n = 6; and I with/without C, no jejunum, n = 10.
Overall, 42/57 (73.7%) pts required any intestinal surgery, and
21/57 (36.8%) required jejunal surgery. Behaviour in jejunal CD,
B1 n = 13, B2 = 36, B3 = 8, is B2 correlated with the need of any
intestinal surgery (p = 0.016 and p = 0.023 for 0 vs ≥ 1 and ≤ vs ≥
1), but not of jejunal surgery (p = 0.10). Perianal CD was observed
in 18 (31.6%) pts, being correlated with the need of any intestinal
surgery (p = 0.025), but not of jejunal surgery (p = 0.71), familial
IBD (p = 0.07), or smoking (p = 0.97). Age at diagnosis was correlated with IS (p = 0.0018), whereas the relation between IS and
S235
CD behaviour was at limit of significance (p = 0.055). The detection
rate of jejunal lesions (but not of CD) significantly increased during follow-up (1979–89; 1990–1999; 2000–2009; 2010–2005; p <
0.0001; Figure 1a) being significantly more frequent after vs before
2000 (p = 0.001; Figure1b). Jejeunal CD was correlated with the
need of surgery (p = 0.0016 surgery ≤ vs > 1; p = 0.022 surgery
0 vs ≥ 1). Therapies: CS in 50/57 (87.7%; B1, n = 12; B2, n = 31;
B3, n = 7), IS in 24/57 pts (42%) (B1, n = 2; B2, n = 17; B3, n = 5),
anti-TNFs in 17/54 (29.8%) jejunal CD pts (B1, n = 4; B2, n = 11;
B3, n = 2).
Conclusions: In a cohort of CD pts, the detection rate of jejunal
lesions (but not of CD) significantly increased during the last few
decades. New imaging techniques may be involved in this finding.
Two third of pts required intestinal surgery, including jejunal surgery
in one third of patients.
P285
Extraintestinal manifestations of Crohn’s disease
have a major influence on anxiety levels and
coping skills
D. Schwartz*1, E. Chernin2, D. Greenberg2, O. Sarid2, V. SlonimNevo2, M. Friger2, H. Vardi2, S. Odes2
1
Soroka UMC, Gastroenterology, Beer Sheva, Israel, 2Ben Gurion
University, Beer Sheva, Israel
Background: Crohn’s disease (CD) is a chronic disease influencing
both physical and social aspects of life. Extraintestinal manifestations
(EIM) including arthropathy, eye inflammation, and skin inflammation are commonly associated with CD, and their direct influence
on anxiety and coping skills may be substantial. We assessed these
psychosocial aspects in Israeli patients with Crohn’s disease.
Methods: Israeli CD patients were asked to fill a questionnaire
containing clinical data, including disease severity by the Harvey–
Bradshaw Index (HBI), symptoms of extraintestinal manifestations,
and psychological data, including the Brief Symptom Inventory (BSI)
and BRIEF COPE Inventory.
Results: Of the available 488 patients, 215 (44%) reported having
symptoms of arthritis or arthralgia; 93 (19.3%) eye inflammation;
51 (10.6%) skin inflammation; and 35 (7.3%) deep skin ulcers. Of
the patients with reported EIM, 61.3% had 1 EIM; 25% had 2 EIM;
9.2% had 3 EIM; and 4.5% had 4 EIM. Females had more EIM
(56% vs 45.1%, p = 0.019). Patients who reported symptoms of
Figure 1. (a) The diagnosis of jejunal lesions in CD significantly increased during follow-up (1979–1989; 1990–1999; 2000–2009; and 2010–2005; p < 0.0001); (b)
being more frequent after vs before 2000 (p = 0.001).

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